Surgery Rounds 3

Question 1

Suspensory Ligament Rupture techniques

Answer 1

1. Strumming or Stretching
2. Hemostat Saw (CATS ONLY)
3. Hemostat roll

Question 2

suspensory ligament - where is it in dogs? what conceals it? mistake to avoid with rupture?

Answer 2

• SL spans from the ovary to the middle and dorsal thirds of the last two ribs
• Dogs – considerable amount of fat conceals the SL and pedicle
• MISTAKE – rupture close to the ovary – too close to pedicle (high risk of hemorrhage)

Question 3

SL rupture for cats
- abdomne anatomy
- what can we see
- careful why

Answer 3

• Cranial cat abdomen is shallow
• SL and pedicle can be readily seen within
  mesovarium
• Proper ligament and ovary are much more fragile – be careful with traction
• Gentle retraction of the proper ligament and ovary caudally
• Sharp dissection of the SL away from the ovarian tissue

Question 4

when we ligate the pedicle, why should we not do a transfixing first?

Answer 4

• we would be going through a live vessel, and it would start to bleed
• so do circumfrential first

Question 5

advantage of aberdeen knot? what is it?

Answer 5

• less bulky knot, like a daisy chain
• good for neuters, allows us to go backwards after subcutaneos to do intradermal line

Question 6

miller’s knot - what is it?

Answer 6

• Pass suture around clamped pedicle twice, the second loop overlaps the first
• Free end passed under and over the first loop to create first throw
• Finished with square knots

Question 7

modified millers knot - what is it?

Answer 7

• Similar to Miller’s knot
• Passing strand of suture material around a clamped pedicle twice (no overlap in the loops)
• Free end passed over and under both loops
• Finished with square knots

Question 8

Consistent consensus on fascial healing includes:
- why do they fail?
- best suture type?
- suture distance from edge?

Answer 8

1. Failure of fascial incisions is often due to early, high mechanical forces
2. Fascial healing optimized by using continuous non- absorbable or slowly absorbable sutures
3. Sutures should be placed a minimum of 3mm from wound edge

Question 9

local factors that impair wound healing

Answer 9

1. Wound Perfusion
2. Tissue Viability
3. Wound Fluid Accumulation
4. Wound Infection

Question 10

systemic factors that impair wound healing

Answer 10

1. Conditions that impair immune function
2. Cancer
3. Age

Question 11

principles of subcutaneous clearing

Answer 11

• Try not to produce dead space
• Don’t dissect out to the side
• Subcutaneous tissue is attached to the linea
• Incise on either side with scissors (create a window)
• One side of the scissor in the window – push forward (push cut)

Question 12

subcutaneous closure principles

Answer 12

• Try not to produce dead space
• Needle superficial to deep and then deep to
  superficial on the same side
• Stay as close to the skin edge as possible if not performing an intradermal suture
• Tack down (in dogs) every 3-4 bites
• No tacking down in cats as they stretch