Had to open up bleedy bitch spay

Re: Had to open up bleedy bitch spay

Anthony Todd — Thu, 24 Apr 2014 09:24:21 GMT

[quote user="Hannah Wynne Richards"]Gillies for everything else.[/quote]

As you only do a few ops you may avoid having calluses like a stonemason.....

Re: Had to open up bleedy bitch spay

Hannah Wynne Richards — Thu, 24 Apr 2014 09:05:06 GMT

I'm like Evelyn Ratchets for cows, Gillies for everything else.

Wynne

Re: Had to open up bleedy bitch spay

Anthony Dennison — Wed, 23 Apr 2014 17:54:51 GMT

Interesting discussion this, as we had to re-open a bitch spay at my practice last week. I did the original spay, it was prepubertal so took me a while to find the uterus as I'm not used to them and my incision was longer than normal. Owners had difficulty keeping her still, said there was a little swelling 2 days post-op which I assumed to be a seroma. Saw it after the weekend and I could feel a large hernia at the cranial end and the wound didn't look nice - re-operated on by a colleague the next day.

She found an infected incision which extended into the muscle, had to cut a lot of muscle back to find healthy tissue. Correction procedure cost almost twice the original cost for the spay!

And I have switched on to Gillies. Hated them when I first started, moved to a branch that has them routinely in kits due to another vets preference. Now hate anything else! Gillies fit my hand better, and they're easier to palm.

Re: Had to open up bleedy bitch spay

Anthony Todd — Wed, 23 Apr 2014 17:07:06 GMT

[quote user="Mark Holmes"]I prefer the ratchet myself. Particularly if there is a lot of suturing.

[/quote]

eg cow caesars! You quickly get used to the click on, click off.

Re: Had to open up bleedy bitch spay

Evelyn Barbour-Hill — Wed, 23 Apr 2014 16:56:45 GMT

[quote user="bob lehner"]Quite agree - but what's really annoying is when you are right-handed and your ops kit contains a left-handed set (or vice versa I guess).[/quote]

Har har, seeing as I had to use right-handed ones in many places for many years, and got quite handy with them, it's nice to think that right handed persons are getting a taste of their own medicine

Re: Had to open up bleedy bitch spay

bob lehner — Wed, 23 Apr 2014 14:21:13 GMT

[quote user="Evelyn Barbour-Hill"]I think Gillies are the bees knees, as long as the jaws and the blades are in good nick of course[/quote]

Quite agree - but what's really annoying is when you are right-handed and your ops kit contains a left-handed set (or vice versa I guess).

Re: Had to open up bleedy bitch spay

Mark Holmes — Wed, 23 Apr 2014 14:14:26 GMT

I prefer the ratchet myself. Particularly if there is a lot of suturing.

Re: Had to open up bleedy bitch spay

Evelyn Barbour-Hill — Wed, 23 Apr 2014 13:39:20 GMT

I think Gillies are the bees knees, as long as the jaws and the blades are in good nick of course, for general surgery. I can't see the need for a ratchet unless you're sewing up a cow and I loathe having to operate a ratchet.

Miniature Foster Gillies for finer stuff like aural resection and the coarser oral surgery.

Silcock's or even Castroviejo for the finer oral surgery where you really need a ratchet or lock.

Maybe it depends whether you've got hands like shovels or dinky little ones?

Re: Had to open up bleedy bitch spay

Bob Russell — Wed, 23 Apr 2014 11:58:04 GMT

I use Gillies but apparently when locum's come in the needle holders (in the kits) seem to be in favour. I find Gillies a 'good fit'!

Re: Had to open up bleedy bitch spay

Mark Hedberg — Wed, 23 Apr 2014 11:43:08 GMT

Olsen Hagars are nice, I do enjoy Gillies though, elegant curve that fits my hand nicely.

Re: Had to open up bleedy bitch spay

ChrisBVSc — Wed, 23 Apr 2014 08:58:14 GMT

[quote user="Anthony Todd"]

I used these, great grip of the needle but they had another name and were longer I think?

[/quote]

Those are McPhail's, used them for cow caesars when I did mixed practice - really strong grip but took me ages to get used to them due to the 'squeeze on, squeeze off' technique required!

For small animal surgery I'm firmly in the Olsen Hegar camp, I just can't understand the logic of Gillies - they contort my hand into a ridiculous position & I can't deal with the lack of ratcheting. Some of our basic stitch kits have them but I'm afraid this always results in a minor tantrum & demands for some 'proper' needle holders from upstairs!

Re: Had to open up bleedy bitch spay

Michael Woodhouse — Tue, 22 Apr 2014 22:08:43 GMT

Mathieu pattern. We have them in the kits with the Gillies, but I very rarely use them. Sharp needle and good technique. It's quite funny me doing some skin stitches and then letting the student have a go......

Re: Had to open up bleedy bitch spay

Anthony Todd — Tue, 22 Apr 2014 22:02:01 GMT

[quote user="Michael Woodhouse"]I've tried practically all the needleholders and I keep resorting back to Gillies. We have the miniature ones in the cat spay kits and even use a pair for most bovine skin. We have the Olsen-Hegar's in some large animal kits and I always feel a little sad when I use them.[/quote]

NZ cows must have much tougher skin....

I used these, great grip of the needle but they had another name and were longer I think?

Re: Had to open up bleedy bitch spay

Michael Woodhouse — Tue, 22 Apr 2014 21:52:48 GMT

[quote user="Thomas Johnson"]They were the only needle holders available in my first practice, it took me a while to get used to them, but 11 years and 3 jobs later I still find them much easier to use than any other needle holder.[/quote]

I've tried practically all the needleholders and I keep resorting back to Gillies. We have the miniature ones in the cat spay kits and even use a pair for most bovine skin. We have the Olsen-Hegar's in some large animal kits and I always feel a little sad when I use them.

Re: Had to open up bleedy bitch spay

emerald — Tue, 22 Apr 2014 20:37:29 GMT

Thank you for all the replies.

Wasn't going to charge differently for if insured or not, was a query rather if this should be goodwill discounted, wrote off or billed as normal in others opinions.

Thank you again, I am feeling better now, think I will just check even more before I sew up now even though I am already known to be very thorough.

Re: Had to open up bleedy bitch spay

Martin Atkinson — Tue, 22 Apr 2014 18:30:07 GMT

[quote user="Anthony Todd"]....your argument above defeats itself, surely?[/quote] Sounds like it doesn't it? What I meant was that it shouldn't go wrong because of a slipping ligature so the reason must be something not directly my fault even though it was a surgical complication. Clients have to accept that complications occur and they are not necessarily the surgeons fault. But If the ligature had slipped then I wouldn't charge.

I had a cat spay that herniated post op and when I opened it up expecting to have to put in just a couple of sutures found the hernia extended literally from the 1 cm flank spay wound to the midline inguinally. There is no way on earth that was due to just wound breakdown due to poor technique, there was either a pre-existing weakness which was not apparent at surgery or the cat had got squashed subsequently. The owner found it very difficult to accept that this was not my fault but I felt it was necessary to charge a fee albeit much reduced from what it would have been if it had been a known trauma. They did accept this and are still very good clients.

Re: Had to open up bleedy bitch spay

Hannah Wynne Richards — Tue, 22 Apr 2014 18:16:59 GMT

It depends on your area, but certainly here, I'd say you should operate FOC if the owners have taken your advice re lungworm treatment (or you've had "issues" about charging, so haven't given proper advice in the 1st place) and charge full whack if they haven't. Charging for materials is unfair to the owner (if it's your fault slipping ligature or failing to give proper prophylactic advice) or unfair to the practice (if the owners haven't done as they were told) Differential charging for insured and uninsured clients is unfair to insurence companies. I feel that approach is strictly fair to everybody.

Wynne

Re: Had to open up bleedy bitch spay

Rob Davis — Tue, 22 Apr 2014 17:54:37 GMT

This was the case in both my first 2 jobs - I was forced to persevere with them, but as soon as I achieved a degree of autonomy I put Olsen-Hagars in all the kits and have been a much happier surgeon ever since!

Re: Had to open up bleedy bitch spay

Anthony Todd — Tue, 22 Apr 2014 17:41:52 GMT

[quote user="Martin Atkinson"] I would not accept this was my fault if I was confident in my surgical technique[/quote]

Um, don't re ipso facto? I wouldn't dream of charging for a routine op that went wrong via a slipping ligature, and your argument above defeats itself, surely?

The PR loss isn't worth it IMHO 'cos the client and all their doggie friends will realise things didn't go right...

Re: Had to open up bleedy bitch spay

Anthony Todd — Tue, 22 Apr 2014 17:33:12 GMT

That's until you try these:

TC Olsen Hegar Needle Holder 14cm

http://www.ebay.co.uk/sch/i.html?_trksid=p2050601.m570.l1313.TR0.TRC0.H0&_nkw=TC+Olsen+Hegar+Needle+Holder+14cm&_sacat=0&_from=R40

Holds with a ratchet, releases with a squeeze, and cuts. Bliss, but each to their own.

No aching wrist or finger, no calluses on your thumb.

Re: Had to open up bleedy bitch spay

Martin Atkinson — Tue, 22 Apr 2014 17:31:39 GMT

[quote user="Malcolm Ness"]I insist that they use a three-clamp method; tie into the crush then twist and shear the tissue between the other two clamps. Routinely use catgut - it isn't necessarily better than other materials but it does the job.. I have to teach/re-teach more than half these people to tie knots - nothing fancy just a predictable surgeon's knot and not a granny or slip knot.[/quote] +1 for this technique not failed me yet but its surprising how many surgeons struggle with 3 clamps. tearing the ovarian pedicle is essential.

Re the fees: I would not accept this was my fault if I was confident in my surgical technique but I feel you have removed one additional form of haemostasis by cutting not tearing the tissue. Also IME Vicryl is not good for laying down tight knots catgut is easier to handle, more secure and lasts long enough. I would charge at least for materials used but if the dog is insured I'd make a direct claim and let them off the excess.

Re: Had to open up bleedy bitch spay

Thomas Johnson — Tue, 22 Apr 2014 17:01:41 GMT

[quote user="Rob Davis"]

[quote user="Evelyn Barbour-Hill"]Were you actually trying to hold your Gillies in your right hand?[/quote]

I have never understood why anybody would choose to use Gillies, horrible things!

[/quote]

They were the only needle holders available in my first practice, it took me a while to get used to them, but 11 years and 3 jobs later I still find them much easier to use than any other needle holder.

Re: Had to open up bleedy bitch spay

Rob Davis — Tue, 22 Apr 2014 16:57:14 GMT

[quote user="Evelyn Barbour-Hill"]Were you actually trying to hold your Gillies in your right hand?[/quote]

I have never understood why anybody would choose to use Gillies, horrible things!

Re: Had to open up bleedy bitch spay

Anthony Todd — Tue, 22 Apr 2014 16:20:35 GMT

[quote user="Evelyn Barbour-Hill"]hold your Gillies[/quote]

Bloody Gillies, gave me calluses on my thumb which took years to go, never gripped with the security of a ratchet clamp and were really tiring to do a big list with!

Don't they come handed anyway?

Re: Had to open up bleedy bitch spay

Tim Charlesworth — Tue, 22 Apr 2014 16:08:40 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Tim Charlesworth"]Catgut is worse for knot loosening no matter how secure it feels when it is tied.[/quote]

Eh? I think not.

Or did you mean "for not loosening"?

Forget me knot.

[/quote]

Surgical (plain) gut has poorer knot security than vicryl, chromic gut is roughly equivalent. There are tables showing the different suture characteristics in most core surgical texts. My point is that catgut is certainly NOT more secure (when knotted) than vicryl but has numerous disadvantages (unpredictable absorption, tissue reaction etc) and so surgeons shouldn't swap to using it for this reason.

Good pun though..