Midline cat spays

Re: Midline cat spays

salome2001 — Thu, 15 Apr 2010 13:36:48 GMT

I was taught by the redoutable Chris Bellenger who would have tied us all up by our toes if we'd suggested using flank spays (or catgut for that matter) so i have always done midline cat spays. I don't think they have more seroma formation (as has been said before, don't mess with the fat, don't let the patient go home and climb the curtains), the linea alba is designed to cut through without haemorrhaging, you get equal access to both L and R sides, there is no problem just extending the incision if you encounter anything unexpected, and it takes no greater time- I generally close in 2 cruciate skin sutures- you just have to learn where to make the incision!!

Re: Midline cat spays

David Strong — Mon, 05 Apr 2010 13:42:13 GMT

Flank speys can be so very much faster for the right candidate - smaller incissions, minimal trauma and working in a less dependent area, less chance of post-op swelling. For ferrals, after closing the deeper layers I used to use single s/c horizontal matress suture in 2-3M gut/vicryl +/- some tissue glue. In private practice I used this approach for some of the animals with owners with excellent results. Not the most important factor I know, but I managed to get my ops time down to about 6-7 mins.

With the wrong candidate - a fat cat, an older cat or one with a larger tract than expected (even if non-gravid), my personal operating time can be twice as long or more with the time discovering your incission is to small, enlarging your incission, disecting away more fat, finding the tract amoungst lashings of fat and then having to place so many extra sutures to get satisfactory closure. My own opinion is that for these animals a flank approach is significantly more traumatic than going straight for a mid-line approach and should be reviewing my own working practices for such cases (which I invariably still approach from the flank!).

The flank approach could be simplified and made less taumatic with the right kit - watch this space!

Re: Midline cat spays

Bob Russell — Thu, 01 Apr 2010 12:15:27 GMT

Midline seems an awful lot of work compared to flank for a routine spay - probably a case of what you are most used to! We did get a number of lumpy mid-lines with vicryl but PDS has never caused a problem.

Re: Midline cat spays

Vikki Moran — Fri, 26 Mar 2010 22:15:09 GMT

i don't routinely use midline spays, i think this is one area where you're probably safest sticking with what you are used to.

i was just going to say though that i don't normally suture subcat fat anymore (flank approaches) as i find the cats seem to be much more sore afterwards, and there's a higher incidence of seroma formation.

I also always use buried sutures in cat spays too.

Re: Midline cat spays

Virginia Campbell — Fri, 26 Mar 2010 17:56:45 GMT

[quote user="Vikki Halliday"]I will generally use a midline approach for any any cat other than a house kept 6 month old.[/quote]

This is what I do, as anything else - at least from spring to autumn - is likely to be pregnant or already spayed. Don't like closing flank and going back in midline just to confirm presence of uterine stump, don't like pulling a pregnant uterus out the side, so I think on balance midline is just as quick.

Re: Midline cat spays

Simon Neuhoff — Thu, 25 Mar 2010 09:47:37 GMT

I trained in South Africa and we were taught midline and my first year in practice I did midline speys. When I came to the UK I was told (but never properly taught) to do flank speys and never really got on with them. After a few years of plugging away with this technique (because clients expected it) I have now reverted to midline speys and far prefer this. I find that, in my hands at least, I have fewer with post op swelling than with flanks. Time wise I think it is down to familiarity with the technique and it takes me the same time, the incision is similar in size.

I use 4/0 vicryl for the linea alba, subcut fat and subcuticular sutures.

Re: Midline cat spays

Evelyn Barbour-Hill — Thu, 25 Mar 2010 03:28:25 GMT

As others have said, I'd call sutures that close the subcutaneous fat subcutaneous.

Closing fat is pretty pointless, but closing areolar tissue is quite desirable in many situations.

What I call my subcuticular sutures take a bite of the tougher connective tissue immediately deep to the dermis. And I do , when closing a midline incision, incorporate a little bit of the linea alba repair in most turns of the continuous subcuticular suture.

The skin won't stay fixed to the underlying muscle for long.

Of course, the gauge of suture material should be appropriate.

Re: Midline cat spays

Rob Reid — Mon, 22 Mar 2010 08:07:45 GMT

I think the key definitely lies in how much you dissect out the subcutanous fat. The cats I have had a bit of post-op swelling in have tended to be the fatter ones where I have more dissection to find the linea alba, obviously as result of creating more dead space.

In terms of suture I think you can take your pick between PDS, vicryl/polysorb & biosyn for your linea alba. I tend to do my intradermals in cats with 4/0 monocryl, though admittedly I mainly do flank speys, so the ones I am doing midline (or ex laps etc) are being billed more so the cost of suture doesn't come into it.

The only other word of caution I would give if using vicryl for your intradermals would be to make sure you do a good job of burying your knot - I find vicryl tends to really irritate the patient if there is any piece showing.

Re: Midline cat spays

nikki — Mon, 22 Mar 2010 00:03:10 GMT

i find the actual spay takes about the same time, and just a little longer to close up. everyone at our practice tends to get a bit of midline swelling, but it resolves quite quickly. we are using 3/0 sutures - either vicryl or PDS in the midline and sub-cut, followed by vicryl/monocryl intradermals or nylon skin sutures. i am an intradermal fan - use it for all neutering.

Re: Midline cat spays

Michael Woodhouse — Sun, 21 Mar 2010 21:10:57 GMT

To you guys who routinely spay cats midline - doesn't it take an awful lot longer? I do as above and only spay cats that are obviously pregnant midline and everything else flank. In all honestly I don't spay that many cats but it only takes 10 minutes from inscision to last suture with just a single cruciate in the skin. People are often amazed how small the hole is - I was once asked if it was some kind of keyhole surgery!

Re: Midline cat spays

Vikki Halliday LLB — Sun, 21 Mar 2010 20:26:19 GMT

I will generally use a midline approach for any any cat other than a house kept 6 month old. I find less problem using flank in very young animals mainly as I think the anaesthetic time is less, and there are fewer sutures.

For a midline I would tend to use 4/0 vicryl or equivalent for everything, continuous linea alba/musculature, continuous sub-cut fat closure (if there is any), and what I have always termed continuous intra-dermal sutures, however I now understand they are also called sub cuticular.

Confusing as I call sub-cut the dead-space ablating fat closure layer...........probably technically very wrong, but who cares? It works and I know what I mean!

Flank speys tend to get I/M , sub-cut fat and intradermal catgut, 4/0, some will also get one supramid mattress suture in the skin.

This was mainly because an old boss of mine once told me off for using only intradermal as a final skin closure, and convinced me that clients "like to see sutures" as it makes them feel you have carried out surgery and more likely to come back for post op checks under the guise of suture removal. Possibly an old fashioned view, but one that did seem to keep the clients happy.

Re: Midline cat spays

Robert Whiteford — Sun, 21 Mar 2010 19:07:46 GMT

[quote user="Charlotte Marshall"]I tend to refer to subcutaneous sutures to close the underlying fat and subcuticular sutures if I am taking non penetrating bites of the underneath of the skin. i thought that was the definition am I wrong?[/quote]

I agree - you are correct

Re: Midline cat spays

Charlotte Marshall — Sun, 21 Mar 2010 18:30:08 GMT

I tend to refer to subcutaneous sutures to close the underlying fat and subcuticular sutures if I am taking non penetrating bites of the underneath of the skin. i thought that was the definition am I wrong?

Re: Midline cat spays

Jon Bray — Sat, 20 Mar 2010 22:10:49 GMT

Evelyn, just to clarify, by "subcuticular" you mean that you're taking non-penetrating bites of the skin from the underside and tacking it to the underlying muscle, leaving the subcuticular fat alone?

I've always taken "subcuticular suture" to mean closure of the subcuticular fat, but I'd agree that given the weakness of the fat there seems little point over and above the closure of dead space. I have sometimes tacked the skin to the underlying muscle in cases such as mammary strips where I anticipated dead space to be an issue but only with some trepidation, on the basis that the skin isn't supposed to be well fixed to the muscle.

Re: Midline cat spays

Evelyn Barbour-Hill — Fri, 08 May 2009 21:56:57 GMT

And did you say you sutured fat? Try not doing that. I think it's pointless usually. Your subcuticular suture will close dead space nicely if you make sure that it engages with the muscle sheath beneath.

Re: Midline cat spays

Evelyn Barbour-Hill — Fri, 08 May 2009 21:49:10 GMT

[quote user="john smith"]I'm not sure if the practice's finances could support using 5/0 suture material for routine ops.[/quote]

John,

I appreciate you don't get much choice in the matter, but you might hint to the boss that the price difference is minimal. (I'm not sure if there is a price difference. £1 a packet maybe?)

Or of course if you are feeling brave you might tell him that "When I'm suturing a cow, I'll use cow sutures. When I'm suturing a cat, I need cat sutures". Hmm. Were you thinking of moving on anyway?

But 3/0 Vicryl is too thick for a cat. Maybe you and the boss could compromise for the time being on 4/0 Vicryl. You could use one packet for every layer then, skin included. In theory it's wrong for the skin, but in practice it seems to work OK. Perhaps a little more likely to be chewed out than Prolene or Ethilon.

5/0 is only fine by comparison with coarser material.

Re: Midline cat spays

Laurence Webb — Tue, 05 May 2009 18:27:34 GMT

I get the opposite to Blair - I tried midline cat spays for a while but went back to flanks because of lots of swelling. I assume the main difference is familiarity with the approach that you use.

I've largely ditched Vicryl and PDS in favour of Biosyn and find I get less tissue reaction to it. It handles better than PDS and knot security is almost as good as vicryl despite being monofilament. It's not ideal where prolongued wound support is required but I find it a pretty good all-rounder for routine stuff. It is slightly more expensive, but still cheaper than using 2 different suture materiels to close up

Re: Midline cat spays

beldather — Tue, 05 May 2009 12:55:02 GMT

Hey John,

As one of those wierd graduates from oz who were taught midline, with flank basically never being discussed, the two most common causes of swelling that I used to see was dead space and too much activity.

Do you clear away sub cut tissue to locate the linea alba? When I stopped doing that my swelling incidence greatly decreased. Keeping cat in the house for a full 7 days definitely help reduce it further again.
Saying that I find I get much more swelling with my flanks speys then I ever did with midline, but I've always chalked that up to being much more confident and surgically softer with my midline. I'm trying to rectify that.

I too have always had better results from PDS then vicryl, but I do sometime wonder if it is once again better familiarity with the material.

Good luck

Blair

Re: Midline cat spays

Ernesto Hernandez — Tue, 05 May 2009 09:50:55 GMT

Thank you Evelyn,

I'm not sure if the practice's finances could support using 5/0 suture material for routine ops. Your advice sounds fantastic, but I'm afraid I won't be allowed to use such a fine material

Thank you

Re: Midline cat spays

Ernesto Hernandez — Tue, 05 May 2009 09:48:51 GMT

Hi Andy,

I'm using 3/0 Vicryl for linea alba, fat and intradermal. The swelling seems to be related to the subcutaneous fat mainly.

I'll try PDS next time!

Re: Midline cat spays

Evelyn Barbour-Hill — Fri, 01 May 2009 20:53:14 GMT

Close linea alba with 5/0 vicryl, subcuticular suture with the same, skin with 5/0 Prolene simple interrupted.

I used to use catgut and there was sometimes swelling with that.

I think one reason for undue swelling is just too much catgut. Another is too heavy a suture material.

Hope this helps.

Re: Midline cat spays

Andrew Kent — Fri, 01 May 2009 19:26:32 GMT

Hi John,

I think midline spays in cats are fantastic and seem to have great results with them - would be interested to know what suture materials you are using - I tend to close muscle with PDS then sub-cut and intradermals with vicryl and have little if any reaction/swelling. As with all surgery minimising dead space and minimum tissue trauma should reduce swelling.

Andy