Bitch spays . Limiting exercise postop

RE: Bitch spays . Limiting exercise postop

Iain Richards — Thu, 30 Mar 2017 21:56:56 GMT

I think the crate didn't help, or rather youngest's dislike of leaving her in the crate at that very early crucial stage. I'm surmising she got used to going outside the cage and can't really distinguish indoor from outdoor. Or to be more accurate "out" is the same as upstairs. Very trying.

RE: Bitch spays . Limiting exercise postop

Clare Tapsfield-Wright — Thu, 30 Mar 2017 21:30:16 GMT

[quote user="Iain Richards"]

Clare - I completely sympathise. My lab is 4 days out op and going nuts with boredom and house training still not there. I'm giving it one more day....

I didn't do the op - just not a reflex any more, but my old practice did a lovely job.

[/quote]Nelly now back to retrieving thank goodness as can tire her out , it's been a hell of a long two weeks. Shame about the housetraining for you , my lurcher was like that. Never reliable. Indoor kennel/ cage has worked a treat for Nelly

RE: Bitch spays . Limiting exercise postop

Iain Richards — Thu, 30 Mar 2017 21:09:23 GMT

Clare - I completely sympathise. My lab is 4 days out op and going nuts with boredom and house training still not there. I'm giving it one more day....

I didn't do the op - just not a reflex any more, but my old practice did a lovely job.

RE: Bitch spays . Limiting exercise postop

Bob Russell — Mon, 27 Mar 2017 16:30:47 GMT

I used to use simple interrupted Vicryl but was persuaded to try Bondek many years ago. Two herniations within days, one a very large Great Dane!

Thankfully both did well with revision surgery but as I removed remnants I could break it with my fingers so almost useless. Not sure if faulty material but sent it back to CEVA (I think, heard nothing more).

Continuous PDS or the Animus equivalent with decent knots (hopefully).

RE: Bitch spays . Limiting exercise postop

Michael Woodhouse — Mon, 27 Mar 2017 16:04:36 GMT

I've used 5 metric PDS for the abdominal closure of cattle paramedian DAs for years and never had a breakdown - there's a lot of weight on those sutures - and that is a hole big enough to put my hand in so more than 10X what you need to spay a bitch.

We use generic Vicryl for midline in bitches

RE: Bitch spays . Limiting exercise postop

Linda Filshie — Mon, 27 Mar 2017 14:21:35 GMT

I routinely use PDS 2 or 3m in most midlines, I don't have any issue with knot security - always use 6-7 throws and make sure they're tight. I don't like the drag of vicryl. Must say I wouldn't use PDS on a viscus though - monocryl is what I would usually reach for.

RE: Bitch spays . Limiting exercise postop

Clive Ansell — Mon, 27 Mar 2017 14:06:31 GMT

Admittedly, the thicker PDS is hard to handle and tie, but I just put loads of throws and pull tight. Never had one come undone or breakdown (AFAIK)

RE: Bitch spays . Limiting exercise postop

Martin Atkinson — Mon, 27 Mar 2017 14:02:02 GMT

[quote user="Clive Ansell"].....will use PDS if healing is likely to be prolonged or complicated in any way. Just need to make sure knots at either end are secure.[/quote]I don't like PDS apart from the very fine stuff 4-6/0 which I would use on internal organs, it is nigh on impossible to get a flat knot that doesn't stick up.

RE: Bitch spays . Limiting exercise postop

Clive Ansell — Mon, 27 Mar 2017 13:49:55 GMT

I routinely use Vicryl simple continuous, but will use PDS if healing is likely to be prolonged or complicated in any way. Just need to make sure knots at either end are secure.

RE: Bitch spays . Limiting exercise postop

Martin Atkinson — Mon, 27 Mar 2017 12:31:22 GMT

Not much discussion as to suture material. I used to use catgut for many years with no problems until about 20 years ago one bitch herniated and ate her own intestines - yuck! I have since used Vicryl and not had another problem. I suspect that some of the mono-filament materials like PDS are harder to get a secure knot which is one reason why not to use them as a continuous mattress suture.

RE: Bitch spays . Limiting exercise postop

Linda Filshie — Sun, 26 Mar 2017 19:32:17 GMT

[quote user="Anthony Todd"]

[quote user="David Mills"]Rather than anecdote there are studies showing continuous to be as strong as interrupted.[/quote]

Let's see 'em then, you know, EBM......

My view is that one stitch, or material failure, in single interrupted is not a disaster.

One stitch in a continuous is..... but the "study" will give us more I hope.

[/quote]

Let me google that for you...

http://www-staro.vef.unizg.hr/vetarhiv/papers/2007-77-5-3.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1465362/pdf/annsurg01273-0060.pdf

and one for horses comparing SI to interrupted cruciate

https://www.ncbi.nlm.nih.gov/pubmed/10582741

RE: Bitch spays . Limiting exercise postop

Anthony Todd — Sun, 26 Mar 2017 16:42:40 GMT

[quote user="David Mills"]Rather than anecdote there are studies showing continuous to be as strong as interrupted.[/quote]

Let's see 'em then, you know, EBM......

My view is that one stitch, or material failure, in single interrupted is not a disaster.

One stitch in a continuous is..... but the "study" will give us more I hope.

RE: Bitch spays . Limiting exercise postop

David Mills — Sat, 25 Mar 2017 23:08:22 GMT

Rather than anecdote there are studies showing continuous to be as strong as interrupted. It's all to do with knot strength.

It's a bit like the urban myth surrounding transfixing sutures in an ovarian pedicle. A bad knot is a bad knot regardless of pattern and likely to fail.

RE: Bitch spays . Limiting exercise postop

Lucy Fleming — Sat, 25 Mar 2017 20:29:08 GMT

I feel like I see more seromas (anecdote alert) in the loopy bitches which have not rested well at all. Same with scrotal swelling in castrates.

Oh, and I also close everything with simple continuous pattern

RE: Bitch spays . Limiting exercise postop

Gillian Mostyn — Sat, 25 Mar 2017 20:21:55 GMT

Most of the wound breakdowns i have seen were using simple interrupted. One with a continuous pattern was due to snapping....But that can also be operator error, if the material is grasped by any metal instrument or accidentally skewered with the needle.

I've always used simple continuous....no ruptures that i can remember.

I think the increased speed, as well as the dramatic reduction in amount of suture material in the wound, makes post op problems less likely anyway.

As far as exercise, my own bitch was tough to keep quiet, and i gave up after 3 days. I tend to think that good technique means that breakdowns shouldn't happen, but resting certainly reduces swelling as there is less 'pulling' and movement at the wounds. I don't, however, tend to blame the client for post op problems unless the exercise levels have been truly excessive. Your sutures should withstand normal movement.

RE: Bitch spays . Limiting exercise postop

Jill Butterworth — Fri, 24 Mar 2017 18:28:57 GMT

I know, I know. I didn't say it was rational, only my rationale ;)

RE: Bitch spays . Limiting exercise postop

Cool — Fri, 24 Mar 2017 15:26:31 GMT

After getting hassled by the boss many years ago that my spays take too long, I have changed to using simple continuous to closed the linea alba, subcutis and intradermals. we are all not very fast surgeons you know but some vets will like you spay a 30kg labrador in 30mins. I always advise no walks, no stairs and no jumping for 10days but dog can have a walk around in garden for wee or poo. I have had one breakdown but was due to owner who let dog out in very large field and didnt end well. otherwise my continuous sutures have not failed and i have had no episodes of seromas either.

RE: Bitch spays . Limiting exercise postop

Anthony Dennison — Fri, 24 Mar 2017 14:58:11 GMT

I have done both simple interrupted and simple continuous. Depends on how large my incision is and how bouncy the animal is.

Generally it's simple continuous. I always wonder whether the multiple sharp ends of suture material in simple interrupted could cause irritation and increase the incidence of post-op seromas.

RE: Bitch spays . Limiting exercise postop

Julie Innes — Fri, 24 Mar 2017 14:54:56 GMT

With bitch spays, I'm afraid I am/was "do as I say, not as I do!" I gave up trying to restrict my loopy border collie (although I did wince when she jumped off a 1m wall at our house 3d later!) Difference is, I knew if wound broke down I had only myself (well, and her!) to blame, and I'd be the one having to fix it, so everyone else gets told on the lead until stitches out!

Another one using simple interrupted too. I understand the logic of continuous, but I can't help feeling it's hanging a lot of weight on 1 length of suture material, as opposed to lots of short lengths, although I know that has no real scientific basis, it's just the way I feel!

RE: Bitch spays . Limiting exercise postop

Clive Ansell — Fri, 24 Mar 2017 13:48:08 GMT

[quote user="louise nixon"]I've seen two spay wounds herniate - both surgeries done by other people using simple continuous pds - I think the knots failed.[/quote]

n=2, out of how many?

I've used a continuous midline suture for >20 years where n = 100's or even 1000's, with only one breakdown to my knowledge.

The late prof Edwards used to close the linea alba of large draught horses with a continuous suture.

RE: Bitch spays . Limiting exercise postop

Rob Loxley — Fri, 24 Mar 2017 13:37:16 GMT

[quote user="louise nixon"]both surgeries done by other people using simple continuous pds - I think the knots failed[/quote]

So the issue was their knot tying, not the suture pattern?

RE: Bitch spays . Limiting exercise postop

louise nixon — Fri, 24 Mar 2017 11:59:48 GMT

I've seen two spay wounds herniate - both surgeries done by other people using simple continuous pds - I think the knots failed. Took an age to resuture due to all the muscle thickening and reaction. Currently I use simple interrupted and can't bring myself to use a continuous suture. Sometimes I use a sort of semi-continuous with knots every inch or so.

RE: Bitch spays . Limiting exercise postop

Linda Filshie — Fri, 24 Mar 2017 08:05:41 GMT

The only bitch spay wound breakdown of mine that I'm aware of came in on her 2-3d post op check soaking wet from gallivanting in the sea. At that stage the linea was intact and strict instructions were given regarding suitable post-op management. 1 week later the dog was back for her final check up with a spay wound sized hernia. She had continued unrestricted exercise with what i consider a predictable effect. Knots (simple continuous) were intact but the suture material -can't remember if vicryl or pds -had broken. I can't be 100% sure this was from the dog's activity - maybe there was a flaw in the material or I damaged it somehow during the op - but I'm pretty bloody convinced.

My own lively 10m bitch I leash walked for 8 days post-spay and kept down to a relatively dull roar for another couple of weeks. I can sympathise with the difficulty of it. I also believe that most owners will only partially obey instructions anyway, so if you're pretty prescriptive and they do 50% of what you ask it may be better than 50% of a laxer regime.

Anyway I wasn't very impressed to hear about this week's 24h-post-pyo springer running round the orchard having a grand old time...

RE: Bitch spays . Limiting exercise postop

Clare Tapsfield-Wright — Fri, 24 Mar 2017 07:12:00 GMT

[quote user="David Mills"]

Continuous sutures are as strong as either knot at each end. Interrupted as strong as each individual knot. Simples. Continuous every day.

I wouldn't rest a dog for that long. It's absolute madness. Does it cover poor technique....?

[/quote]absolutely not David but I am intrigued that we vets perform this surgery so frequently and send them home to the owner , job done, without much thought to how easy the aftercare instructions are to adhere to. I was prepared with an indoor kennel knew what to expect and aware of the potential problems if I gave in to the patient who clearly felt she could have cleared a dry stone wall as usual if allowed to. I suspect many owners do just let them go on as usual in which case why are we giving out such strict post op care instruction. Is it evidence based or defensive?

RE: Bitch spays . Limiting exercise postop

David Mills — Fri, 24 Mar 2017 01:06:57 GMT

Continuous sutures are as strong as either knot at each end. Interrupted as strong as each individual knot. Simples. Continuous every day.

I wouldn't rest a dog for that long. It's absolute madness. Does it cover poor technique....?