new job, new suture materials

Re: new job, new suture materials

Mark Holmes — Tue, 03 Sep 2013 06:28:44 GMT

[quote user="Lorna McHardy"]

A word of caution on the 'just one packet' technique.... I used to do this, until the Sunday I got a panicked call from an owner whose bitch I had spayed on Friday. She had had a reaction to the suture material (it was vicryl, but suture reactions can happen to anything after all), and the entire wound had broken open, spilling all her intestines onto the floor. She was going loopy, and trying to eat them.

Now, I realize this is unusual, and all was well in the end, but suture reactions do happen. So that was the last time I used only one suture material for all three layers and I wouldn't take the risk again for want of a packet of suture material.

[/quote] I have seen THAT happen with every type of suture material. ( not to me thankfully) I think it's a mistake to blame it on the one suture packet. It's an easy assumption but you can't make simple assumptions from one case. That's what homeopaths do!

Re: new job, new suture materials

Anthony Dennison — Tue, 03 Sep 2013 00:34:37 GMT

I've done a couple of bitch spays since your advice Evelyn, and have found the skin does close much more neatly. Thanks!

Re: new job, new suture materials

Thomas Johnson — Thu, 29 Aug 2013 08:54:43 GMT

[quote user="Evelyn Barbour-Hill"]

Even supposed experts like vet school surgeons sometimes seem to use material that's much too thick and sutures that are much too clumsy, to judge by the photographs they publish.

[/quote]

They probably do the specialist surgery, then get a student to close the wound!

Re: new job, new suture materials

Evelyn Barbour-Hill — Wed, 28 Aug 2013 22:39:43 GMT

[quote user="Michael Woodhouse"]

[quote user="Evelyn Barbour-Hill"]Ok. It's just that I wouldn't dream of using anything thicker than 4/0 for s/c and skin. 6/0 for cats.[/quote]

Seriously? 4/0 is 1.5 metric! I use 3 metric dog dog skin and 2 metric for cats.

I see why you use loupes!

(8 metric for cows and sheep)

[/quote]

Yes, seriously. Is that so strange? You don't need loupes for that.

When i'm suturing a cow I use cow-size sutures, when I'm suturing a cat I use cat-size sutures.

I've occasionally been presented, by people who have moved house for instance, with cat spays done with clonking great cow sutures and although it's true they heal it's not a pretty sight.

Even supposed experts like vet school surgeons sometimes seem to use material that's much too thick and sutures that are much too clumsy, to judge by the photographs they publish.

Re: new job, new suture materials

Michael Woodhouse — Wed, 28 Aug 2013 18:50:35 GMT

[quote user="Evelyn Barbour-Hill"]Ok. It's just that I wouldn't dream of using anything thicker than 4/0 for s/c and skin. 6/0 for cats.[/quote]

Seriously? 4/0 is 1.5 metric! I use 3 metric dog dog skin and 2 metric for cats.

I see why you use loupes!

(8 metric for cows and sheep)

Re: new job, new suture materials

Anthony Dennison — Wed, 28 Aug 2013 16:29:33 GMT

[quote user="Evelyn Barbour-Hill"]Ok. It's just that I wouldn't dream of using anything thicker than 4/0 for s/c and skin. 6/0 for cats.[/quote]

Really?! Wow, may have to look at technique and change it a bit. I guess I do use similar to you for suturing skin wounds, so should really adapt that approach to my general surgery.

Re: new job, new suture materials

Anthony Todd — Wed, 28 Aug 2013 15:46:42 GMT

[quote user="Lorna McHardy"]a reaction to the suture material [/quote]

Mmmm, why was it a "reaction"? Had the vicryl dissolved or what?

I used to have the knots untie or pull through the tissue if the gauge was too fine, or I'd pulled the stitch too tight independent of material.

And that was always with cat-gut on a reel 'cos that's all we used.

I never could work out what I'd done differently or why that particular knot had come undone. Carelessness or trying to hurry too much I guess.

The only difference in brands seemed to be tensile strength but sometimes stitches are overtightened anyway; did lead to local ischaemia and "reaction" sometimes, particularly in the skin.

Re: new job, new suture materials

Evelyn Barbour-Hill — Wed, 28 Aug 2013 14:49:30 GMT

[quote user="Anthony Dennison"]

[quote user="Evelyn Barbour-Hill"]

[quote user="Anthony Dennison"]On a good day, with a small bitch, I only need 1 packet of suture material.[/quote]

Doesn't that mean you are using too coarse a gauge for the skin, or too fine a gauge for the body wall?

[/quote]

It doesn't happen very often, but with bitch spays I will use 2/0 PDS. Erring on the more coarse for skin, but can't think off the top of my head any that have had a problem.

95% of the time I will use 2/0 for ligatures and body wall, then use 3/0 for s/c and skin.

[/quote]

Ok. It's just that I wouldn't dream of using anything thicker than 4/0 for s/c and skin. 6/0 for cats.

Re: new job, new suture materials

Anthony Dennison — Wed, 28 Aug 2013 14:25:18 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Anthony Dennison"]On a good day, with a small bitch, I only need 1 packet of suture material.[/quote]

Doesn't that mean you are using too coarse a gauge for the skin, or too fine a gauge for the body wall?

[/quote]

It doesn't happen very often, but with bitch spays I will use 2/0 PDS. Erring on the more coarse for skin, but can't think off the top of my head any that have had a problem.

95% of the time I will use 2/0 for ligatures and body wall, then use 3/0 for s/c and skin.

Re: new job, new suture materials

Evelyn Barbour-Hill — Wed, 28 Aug 2013 12:01:40 GMT

[quote user="Anthony Dennison"]On a good day, with a small bitch, I only need 1 packet of suture material.[/quote]

Doesn't that mean you are using too coarse a gauge for the skin, or too fine a gauge for the body wall?

Re: new job, new suture materials

Anthony Todd — Wed, 28 Aug 2013 11:45:54 GMT

[quote user="Linda Filshie"]/quote] Umm, yerwhat? No suddenly about it, Anthony, as I've been using it for 10 years plus.[/quote]

Good on yer, Cat gut went through a long period of sneer and ridicule and on this very forum.

Re: new job, new suture materials

Linda Filshie — Wed, 28 Aug 2013 11:39:14 GMT

[quote user="Anthony Todd"]

[quote user="Linda Filshie"]And another +1 for catgut ligatures.

[/quote]

At last something all the dinosaurs did for many years with no problems has suddenly been recognised.

[/quote] Umm, yerwhat? No suddenly about it, Anthony, as I've been using it for 10 years plus.

Re: new job, new suture materials

Lorna McHardy — Wed, 28 Aug 2013 11:36:34 GMT

Re: new job, new suture materials

Anthony Todd — Wed, 28 Aug 2013 11:21:42 GMT

[quote user="Linda Filshie"]And another +1 for catgut ligatures.

[/quote]

At last something all the dinosaurs did for many years with no problems has suddenly been recognised.

Re: new job, new suture materials

Anthony Dennison — Wed, 28 Aug 2013 10:25:49 GMT

I personally use PDS for everything. I find I can get a better ligature with it than vicryl, and I really dislike the felling of the drag through the tissue that vicryl gives (though that may be because we're using a cheaper alternative).

On a good day, with a small bitch, I only need 1 packet of suture material. Cat spays regularly have plenty spare from one packet, used for everything.

Re: new job, new suture materials

Linda Filshie — Wed, 28 Aug 2013 10:15:44 GMT

And another +1 for catgut ligatures.

Re: new job, new suture materials

Nicola Cole — Wed, 28 Aug 2013 00:17:35 GMT

+1 for catgut for ligatures!

Re: new job, new suture materials

Hannah Wynne Richards — Tue, 27 Aug 2013 11:20:27 GMT

I'm another who likes catgut for ligatures !

Wynne

( OK-entitled to be a dinosaur-occasionally-at my age )

Re: new job, new suture materials

Yantha Smyth — Mon, 26 Aug 2013 16:40:17 GMT

Hi, like you I have started out using gut for ligatures. A few years ago I started a new job and the place point blank refused to stock gut, so I had to start trying alternatives. I found that unlike many people who seem to get on with vicryl or similar, I can not seem to tie a secure vicryl ligature that I am happy with- and now avoid it (for ligatures). I found that the monofilaments have been more reliable in my hands as an alternative to gut, but I now always double ligate any pedicels- an encircling proximal and a transfixing distally... Takes longer but can feel confident with it, so worth it. Now locumming I need to be able to use what is available, but if no gut I still have been able to avoid relying on vicryl. Recently been using biosyn which I really like- secure but doesn't persist as long as pds.

Re: new job, new suture materials

Rob Loxley — Sun, 25 Aug 2013 12:17:56 GMT

[quote user="James Laidlaw"]How does vicryl - a braided multifilament - slip more and have less friction[/quote]

This was with reference to tying nots, not necessarily passage through tissue; it is a coated braided suture material.

Re: new job, new suture materials

Laurence Webb — Sun, 25 Aug 2013 00:13:07 GMT

[quote user="Francisco Gomez"]She was joking. It took me a while to get her sense of humour.. Must be the 'neo-colonialist' approach... ;-)

[/quote]Oops.

Personally, I like Biosyn. Monofilament (so no drag), has the knot security of PDS without the memory but is as strong as a polyfilament like Vicryl. It also seems to cause much less inflammation than Vicryl in the skin. You can do a bitch spay (and most ops) with just one packet, from ovarian pedicles, cervix, linea alba, s/c fat and intradermal.

Re: new job, new suture materials

Glenn Hodgson — Sat, 24 Aug 2013 22:09:37 GMT

Any one else uswing polysorb? I like its knot security over vicryl.

I did sleep more soundly when using gut, even though no issues in the past 3 years with polysorb. Catgut 'locks' a treat.

I noticed a clear improvement in mammary strip morbidity after quickly moveing away from it SQ.

Re: new job, new suture materials

Francisco Gomez — Sat, 24 Aug 2013 16:18:50 GMT

He was joking. It took me a while to get his sense of humour.. Must be the 'neo-colonialist' approach... ;-)

Re: new job, new suture materials

Andrew Henfrey — Sat, 24 Aug 2013 16:12:58 GMT

[quote user="Evelyn Barbour-Hill"]The more packets, and the more expensive the type. you open and use, the more profit for your employer. Does that help? [/quote]

Doesn't apply if neuterings are fixed cost, and sutures are not priced separately. Just the opposite!

Re: new job, new suture materials

Evelyn Barbour-Hill — Sat, 24 Aug 2013 15:19:45 GMT

[quote user="SER"]Think I'll have to work on not feeling guilty about the number of packets of suture material I open[/quote]

The more packets, and the more expensive the type. you open and use, the more profit for your employer. Does that help?