Catgut

RE: Catgut

Malcolm Ness — Tue, 11 Jul 2017 11:01:45 GMT

[quote user="Iain Richards"]showing gut is inferior to anything else. [/quote]

Remember to correct for size/thickness. Also, a material is either strong enough or it isn't - there is no virtue in specifying something that is 10 or 20 times stronger than it needs to be.

The first chapters in most of the veterinary and human surgical textbooks (Slatter or Fossum in SA surgery, for example) are usually about "Surgical Biology" and therein you will find a good review/roundup of a lot of pertinent material (almost all based on previously peer-reviewed, published information) about a wide range of surgical stuff including suture and ligature materials. It is a shame that so few people read it.

RE: Catgut

Iain Richards — Tue, 11 Jul 2017 10:31:23 GMT

Just to bring these threads together if someone is skimming through, as there are two areas. One is the relative reaction to materials which, from David's refs, are not much different in the amount of fibrous reaction (interesting, as I'd always been taught that gut created more reaction). The other are relates to tensile strength, my refs, showing gut is inferior to anything else.

RE: Catgut

Niall Taylor — Sun, 09 Jul 2017 16:11:15 GMT

[quote user="David Mills"]There are a couple it seems. The one I referenced is from 1995, so not hat recent, but interesting nonetheless.[/quote]

Thanks.

Niall

RE: Catgut

Alastair Franklin — Sun, 09 Jul 2017 12:30:25 GMT

[quote user="bevs2251"]

If case goes to Vet Surgeon's Board, specialists won't support you if you have used catgut or cassette absorbables (here in Australia, at least).

[/quote]

Whilst cassette materials may not the first choice of many (most?) specialists in Oz, I find your statement hard to believe re specialists and defence. If handled appropriately, sterility can potentially be maintained. Do you have any evidence for your statement on the VSB?

RE: Catgut

Nicola Cole — Fri, 07 Jul 2017 11:12:20 GMT

[quote user="bevs2251"]

Haven't used it for years. Seen many problems with catgut. Don't even use cassette monofilament absorbable suture material (sterility cannot be guaranteed once started). Only ever use swaged on absorbables now - bosses can like it or lump it, won't compromise on that. If case goes to Vet Surgeon's Board, specialists won't support you if you have used catgut or cassette absorbables (here in Australia, at least).

[/quote]

Never had a problem using cassettes and as far as I'm aware there is no evidence to suggest they are a problem when used in appropriate situations and importantly with a sharp rather than blunt needle re: tissue damage (but that's another topic!).

The only problem I have seen with catgut was a colleague using it midline, sutures placed too far apart and not enough throws-whatever material was used I would suspect it would have broken down.

RE: Catgut

Anthony Todd — Fri, 07 Jul 2017 09:47:04 GMT

[quote user="Martin Atkinson"]]I have never knowingly had a problem with cassette suture materials even after they have been open for many months. [/quote]

Me neither. Funny how surgery and anaesthetic problems are always blamed on the material and never the operator.....

I've known vets send off thiopentone soln. for culture after an anaesthetic death or a slough!

RE: Catgut

Martin Atkinson — Fri, 07 Jul 2017 09:27:13 GMT

[quote user="bevs2251"] Don't even use cassette monofilament absorbable suture material (sterility cannot be guaranteed once started).[/quote]I have never knowingly had a problem with cassette suture materials even after they have been open for many months. They are designed to be reused so I would doubt that there would be any repercussion legally if a patient did get a wound infection. Sounds as though they're a bit anally retentive in Oz!

RE: Catgut

Malcolm Ness — Fri, 07 Jul 2017 07:51:32 GMT

[quote user="bevs2251"]If case goes to Vet Surgeon's Board, specialists won't support you if you have used catgut or cassette absorbables [/quote]

I use it where appropriate.

[quote user="bevs2251"]Seen many problems with catgut.[/quote]

Have you considered that your technique, and not the material, might be the causal factor?

Unsupported dogma is rarely helpful.

RE: Catgut

bevs2251 — Fri, 07 Jul 2017 05:29:43 GMT

RE: Catgut

David Mills — Mon, 26 Jun 2017 15:31:17 GMT

[quote user="Niall Taylor"]

[quote user="David Mills"]There was a study that showed after 2 weeks thee was no difference between Catgut, pds and I think vicryl[/quote]

Do you have a reference please?

Niall

[/quote]

There are a couple it seems. The one I referenced is from 1995, so not hat recent, but interesting nonetheless.

https://www.ncbi.nlm.nih.gov/pubmed/?term=Quantitative+analysis+of+the+inflammatory+reaction+surrounding+sutures+commonly+used+in+operative+procedures+and+the+relation+to+postsurgical+adhesion+formation

Also an older one in cats, similar results:

https://www.ncbi.nlm.nih.gov/pubmed/2976549

RE: Catgut

David Mills — Mon, 26 Jun 2017 15:26:59 GMT

Currently reading a great book "Matters of the Heart - A History of Heart Surgery in 10 operations".

One of the first series of successful heart surgeries was done in a field clinic next to the Fosse Way in the second world war, such as removing shrapnel from the muscle or chambers of the heart.

Guess what material they used to sew the heart back up again? Does make you think...

RE: Catgut

Robin Grimmer — Wed, 21 Jun 2017 21:32:39 GMT

[quote user="robloxley"]

[quote user="Robin Grimmer"]linea alba (always simple interrupted )[/quote]

Why? Another dogma?
Really don't remember the last midline I didn't close with a simple continuous pattern.

[/quote]

Nope. I've had 2 reclose a couple of midline wounds where a continuous suture had failed - not by me, and was two different surgeons.

RE: Catgut

Rob Loxley — Wed, 21 Jun 2017 20:45:16 GMT

[quote user="Robin Grimmer"]linea alba (always simple interrupted )[/quote]

Why? Another dogma?
Really don't remember the last midline I didn't close with a simple continuous pattern.

RE: Catgut

Michael Woodhouse — Wed, 21 Jun 2017 12:22:23 GMT

[quote user="Evelyn Barbour-Hill"]Stop pulling when it starts to go white then.... [/quote]

I think that's just good advice for life........

RE: Catgut

Evelyn Barbour-Hill — Wed, 21 Jun 2017 12:20:27 GMT

[quote user="Robin Grimmer"]The thing I hate about cat gut is if you pull it tight it goes white and then snaps unless you use really thick.[/quote]

Stop pulling when it starts to go white then....

RE: Catgut

Michael Woodhouse — Wed, 21 Jun 2017 12:17:08 GMT

We use 6 metric chromic catgut for ligatures in bitch spays and I have to moderate my force not to snap it when pulling tight. 8 metric in cows can take some pulling but I can snap it if I put my heart and sole into it (or she's a bitch).

RE: Catgut

Martin Atkinson — Wed, 21 Jun 2017 12:02:05 GMT

[quote user="Robin Grimmer"]

The thing I hate about cat gut is if you pull it tight it goes white and then snaps unless you use really thick.

[/quote]I think you are having too many Weetabix for breakfast Robin! Seriously I rarely find this a problem and predominantly use 3/0 and 2/0. It can however vary from batch to batch and how long it has been opened. It possibly deteriorates in the cassette if you are using it only infrequently.

RE: Catgut

Lucy Fleming — Wed, 21 Jun 2017 11:52:09 GMT

[quote user="Robin Grimmer"]The thing I hate about cat gut is if you pull it tight it goes white and then snaps unless you use really thick.[/quote]

I don't tend to find this an issue (unless I am having a particularly stroppy day) but do find you have to tighten the first throw with a lot more care/ more slowly than with something like vicryl

RE: Catgut

Robin Grimmer — Wed, 21 Jun 2017 11:41:27 GMT

I love vicryl for ligation and linea alba (always simple interrupted ). The thing I hate about cat gut is if you pull it tight it goes white and then snaps unless you use really thick. You can pull vic really tight and it won't snap. 4m is great for fat or large dog bitch spays.

RE: Catgut

David Mills — Wed, 21 Jun 2017 11:36:38 GMT

[quote user="Michael Woodhouse"]

I'm sure there is more pressure on a cow's flank after a caeser compared to a dog linea alba and catgut seems fine for that.....

I wouldn't use it by choice, but I'm sure it would be fine most of the time. I did use it as a student one place I saw practice for a few bitch spays and they never had a problem. I remember asking about it.

[/quote]

I was thinking about cows in relation to this. I suppose the flank is under less continuous pressure eg when lying down just like in cat flanks.

Catgut probably is strong enough but the margin of error lower compared to other materials.

RE: Catgut

Bob Russell — Wed, 21 Jun 2017 10:44:07 GMT

I would not dream of using PDS for ligatures. It is anything but easy to knot and I cannot see why anyone would want to use it for that purpose.

Catgut is really nice to knot and grips well so unlikely to loosen as you ligate. I think we may still have some but for ligatures I would tend towards Vicryl/Polysorb etc.

PDS or equivalent in abdominal wall, almost indestructible. I did use Vicryl but a couple of scary events with Bondek made me move over to PDS despite its handling characteristics.

RE: Catgut

Martin Atkinson — Wed, 21 Jun 2017 10:34:00 GMT

[quote user="Martin Hamilton"]

University recommended PDS for all ligatures in the abdomen and linea, with Monocryl in the subcut and skin. Their reason for Monocryl over Vicryl was less drag due to its monofilament nature, therefore less trauma to the skin and reduced infection rates. Monofilament is a big buzzword in Edinburgh it would seem.

In practice, however, I use catgut for my ligatures, with one transfixing PDS on the cervix and a circumferential catgut more caudally to it. Linea always closed with PDS, Vicryl for everything else. So far so good!

[/quote]In practice I find PDS is difficult to handle, difficult to tie secure knots without multiple throws and leaves an unsightly row of knobbly bits under the skin unless you have an animal with a deep layer of sub cut fat. I reserve it for ops where monofilament is indicated to prevent wicking i.e. intestinal/bladder surgery and where the protracted re-adsorption time is useful i.e. in tendons. Vicryl is perfect for the linea alba.

RE: Catgut

Braden Collins — Wed, 21 Jun 2017 03:11:13 GMT

I loved catgut for ligatures. I found it wouldn't slip open between throws and gave good, secure knots.

I had the fear of god put into me about it for closing muscle layers so always felt nervous using it to close the abdomen of pets, though I used it for years quite happily to close cows post-caesar. It must have been a bit tougher than we were taught by the smallies surgeons as cows were rubbish at keeping quiet, especially the station cattle I worked on for my first two years.

RE: Catgut

Evelyn Barbour-Hill — Wed, 21 Jun 2017 00:53:02 GMT

[quote user="Martin Hamilton"]I think the whole university attitude has a few factors contributing towards it, what with a lack of a real competitive business model, as well as being in their own insular little world.[/quote]

[quote user="Martin Hamilton"] As many of you more expereinced vets have noted, catgut for linea isn't ideal due to its short retention of tensile strength, and I wouldn't even dream of using it for this purpose. I hadn't even heard of it until this post![/quote]

From Surgery of the Dog and Cat by Noel Ormrod, published 1966

"..... suture the peritoneum and the deep sheath of the rectus abdominis together, using a continuous stitch of No. 0 or No. 1 chromic catgut. "

Those lecturers are so clever that they don't even know the history of their own profession. Why do you think catgut was used for many many decades if it is such a despicable material?

RE: Catgut

Rob Loxley — Tue, 20 Jun 2017 23:26:43 GMT

[quote user="Martin Hamilton"]Linea always closed with PDS[/quote]

Can't see why not to use vicryl, apart from personal preference (of you and/or your lecturers). Interestingly when I was taught surgery it was much less proscriptive than you describe, more these are the ways to do it with pros and cons, here's what we do, but draw your own conclusions. Except suturing the skin with a straight needle handheld...