Use of Monocryl for Linea Closure after Abdominal Surgery

RE: Use of Monocryl for Linea Closure after Abdominal Surgery

rachaelyost — Thu, 20 Jun 2019 12:05:09 GMT

One of the practices I do locum work for uses monocryl for linea alba closures routinely. I also use PDS and vicryl depending on what practice I am at. I have yet to come across any more problems with monocryl over the other suture materials (cue a midline breakdown....)

RE: Use of Monocryl for Linea Closure after Abdominal Surgery

Charlotte Marshall — Fri, 14 Jun 2019 13:00:08 GMT

We used to use monofilament nylon for closing dog midlines for a long time but changed some years ago. Now we use a PDS type suture. The worst thing with the monofilament was if you had to reop a dog and take the damn things out especially if it was simple interrupted!

RE: Use of Monocryl for Linea Closure after Abdominal Surgery

Aurelia Verdin — Thu, 13 Jun 2019 06:36:11 GMT

I'm working in Melbourne now, when I started over here I was locuming and most of the practices I was at, including the one I'm at full time now, use Monocryl for most things, including closing linea alba.

It's taken me a while to get used to it for ligatures, and I still prefer Vicryl for these if I can, but otherwise I haven't seen any issues so far with more rapid breakdown. I would guesstimate a similar number of mild suture reactions to what I saw in the UK where my practice used Vicryl for linea alba/fat, and either Vicryl intradermals or nylon skin sutures depending on the vet.

RE: Use of Monocryl for Linea Closure after Abdominal Surgery

Evelyn Barbour-Hill — Thu, 13 Jun 2019 00:31:24 GMT

[quote user="Yantha Smyth"]

I read that monocryl loses 50% of in vivo tensile strength by 7 days and 60-70% by 14 days (slight variation if dyed vs non-dyed) which is why I was uncomfortable about the idea of relying on it for abdominal wall closure.

I have been unable to broach the topic with the surgeon involved as I have never met them and am sole charge at a different branch in this post, so felt it may a bit of an awkward conversation-starter and not even face to face; and like others have said if thats what they do, are comfortable with it and don't have any problems then it may not be welcome or appropriate to stick my nose in! But it did make me question whether my take on monocryl was misguided.

[/quote]

Maybe that surgeon uses material that's much too thick, so even 50% of its strength is still enough?

Somebody mentioned suturing gut, uterus and bladder. I've used Vicryl exclusively in those sites for many years. Since the material doesn't penetrate the lumen, I really can't see the famous wicking as an issue.

RE: Use of Monocryl for Linea Closure after Abdominal Surgery

Beats — Wed, 12 Jun 2019 22:00:25 GMT

[quote user="Peter Faulkner"]Does anyone still use mono-filament nylon to close canine midlines? .....I'm asking for a friend ;)[/quote]

Sometimes, but only when the cheap PDS on a reel runs out and I'm performing a fixed-price procedure, i.e. bitch spay, which does not permit for me to open a tidy packet of something (or I expect very slow wound healing).

The occasional one needs the sutures removed years later, but that's more often due to technical error or SC use (which I guess is also a technical error as that should be catgut ;-)

Biggest advantage is being able to tell if a bitch is spayed by palpation :-)

RE: Use of Monocryl for Linea Closure after Abdominal Surgery

Yantha Smyth — Wed, 12 Jun 2019 20:34:05 GMT

Thanks for the input everyone.

Yes I am also a catgut fan for ligatures, but if not available will reach for a monofilament since I cannot for the life of me do a secure ligature with vicryl to this day!

RE: Use of Monocryl for Linea Closure after Abdominal Surgery

vs0u — Wed, 12 Jun 2019 20:01:19 GMT

[quote user="Peter Faulkner"]Does anyone still use mono-filament nylon to close canine midlines?[/quote]

There's a practice I sometimes work at where some older bitches have nylon stitches in the midline - presumably been there for a few years - doesn't seem to cause them any problems although it feels a bit odd from the outside!

RE: Use of Monocryl for Linea Closure after Abdominal Surgery

Anthony Todd — Wed, 12 Jun 2019 18:31:20 GMT

[quote user="Peter Faulkner"]Does anyone still use mono-filament nylon to close canine midlines?[/quote]

All the dinovets I knew tried it but, i think I'm right in saying, it was hard to knot, inflexible and the ends were "prickly.

Vetafil was lovely, softish and knotible. Pity more dinovets aren't on here to confirm, but they tell me it's a waste of time as hard won experience counts for nought in the modern field of dogmatic vetmed.

RE: Use of Monocryl for Linea Closure after Abdominal Surgery

Peter Faulkner — Wed, 12 Jun 2019 18:09:41 GMT

[quote user="GrooveJet"]

[quote user="Anthony Todd"]

I am pretty sure all the vets I knew in dogs just used chromic gut in various sizes on those multiuse reels for everything except the skin which was always Vetafil, [or nylon??]

Cats were just catgut everywhere, always without buster collars except aural surgery; dogs too.

We did change latterly and had cats back for stitch removal as owners seemed to expect it [at no charge!!]

Swaged needles and fine catgut used where appropriate.

The abdomen was closed with usually single interrupted chromic gut the excuse was that a knot failure wasn't catastropic as there were good sutures near by, hopefully.

Breakdowns were rare, usually/always operator caused and suture interference, provided sutures weren't too tight, non-existent.

No gloves ever, without sequel, except with a vet's cat-bite or scratch where a "wound infection" was usually guaranteed. [penicillin pre or post or when needed always effective]

[/quote]

Aaaah, those blissful Dinovet Days!!!

[/quote]

Does anyone still use mono-filament nylon to close canine midlines? .....I'm asking for a friend ;)

Seriously, I only ever used PDS once, on a cat midline. It reacted to them for some reason. I had to go back in and remove every single stitch and replace it with monofil nylon. After which it was fine.

If there's a Dinovet badge or medal? I'd very much like to claim mine.

RE: Use of Monocryl for Linea Closure after Abdominal Surgery

Anthony Todd — Wed, 12 Jun 2019 18:07:55 GMT

[quote user="GrooveJet"]Aaaah, those blissful Dinovet Days!!![/quote]

Well not when all your younger colleagues were rapidly, and gleefully informed, that the boss's one C/S had pulled her stitches out!

My point was not how good or bad the materials we used were, but how a sympathetic technique, which can't be taught easily, is the main cause of suture trouble.

You're anonymous, so nobody knows how good you are [I'm sure it won't be "were"], so can't really weigh your opinion anyway..............

RE: Use of Monocryl for Linea Closure after Abdominal Surgery

Miriam Lodewyks — Wed, 12 Jun 2019 17:49:56 GMT

[quote user="Anthony Todd"]

I am pretty sure all the vets I knew in dogs just used chromic gut in various sizes on those multiuse reels for everything except the skin which was always Vetafil, [or nylon??]

Cats were just catgut everywhere, always without buster collars except aural surgery; dogs too.

We did change latterly and had cats back for stitch removal as owners seemed to expect it [at no charge!!]

Swaged needles and fine catgut used where appropriate.

The abdomen was closed with usually single interrupted chromic gut the excuse was that a knot failure wasn't catastropic as there were good sutures near by, hopefully.

Breakdowns were rare, usually/always operator caused and suture interference, provided sutures weren't too tight, non-existent.

No gloves ever, without sequel, except with a vet's cat-bite or scratch where a "wound infection" was usually guaranteed. [penicillin pre or post or when needed always effective]

[/quote]

Aaaah, those blissful Dinovet Days!!!

RE: Use of Monocryl for Linea Closure after Abdominal Surgery

Joyce Whitehead — Wed, 12 Jun 2019 17:29:08 GMT

[quote user="Anthony Todd"]

Am I correct in believing that buster collars after any suturing are now mandatory?

[/quote]

Certainly not, we barely use them.

I‘m not a monocryl user, to get back to the original question. I use vicryl or catgut for ligatures and PDS for midline. I use PDS for suturing gut, uterus, bladder etc due to the non wicking potential after a CPD a couple of years ago. Mostly these days we use intradermal vicryl rapide for skin closure.

RE: Use of Monocryl for Linea Closure after Abdominal Surgery

Thomas Johnson — Wed, 12 Jun 2019 17:28:09 GMT

[quote user="Anthony Todd"]Am I correct in believing that buster collars after any suturing are now mandatory?[/quote]

Definitely not! I spend a surprising amount of time either reassuring or persuading owners that they don't need them.

RE: Use of Monocryl for Linea Closure after Abdominal Surgery

Gillian Mostyn — Wed, 12 Jun 2019 17:19:33 GMT

[quote user="Anthony Todd"]Am I correct in believing that buster collars after any suturing are now mandatory?[/quote]

RE: Use of Monocryl for Linea Closure after Abdominal Surgery

Anthony Todd — Wed, 12 Jun 2019 16:47:37 GMT

I am pretty sure all the vets I knew in dogs just used chromic gut in various sizes on those multiuse reels for everything except the skin which was always Vetafil, [or nylon??]

Cats were just catgut everywhere, always without buster collars except aural surgery; dogs too.

We did change latterly and had cats back for stitch removal as owners seemed to expect it [at no charge!!]

Swaged needles and fine catgut used where appropriate.

The abdomen was closed with usually single interrupted chromic gut the excuse was that a knot failure wasn't catastropic as there were good sutures near by, hopefully.

Breakdowns were rare, usually/always operator caused and suture interference, provided sutures weren't too tight, non-existent.

No gloves ever, without sequel, except with a vet's cat-bite or scratch where a "wound infection" was usually guaranteed. [penicillin pre or post or when needed always effective]

Am I correct in believing that buster collars after any suturing are now mandatory?

RE: Use of Monocryl for Linea Closure after Abdominal Surgery

Sarah Wheadon — Wed, 12 Jun 2019 16:30:57 GMT

[quote user="Julie Innes"]monocryl was good fro bladders/[/quote]

I thought so too, but watched a webinar that warned that if a bladder has Proteus, there can be dehiscence if monocryl used so best to reach for the PDS for all cystotomies.

RE: Use of Monocryl for Linea Closure after Abdominal Surgery

Julie Innes — Wed, 12 Jun 2019 15:03:16 GMT

I always use PDS midline. I was told at a CPD that monocryl was good fro bladders/ intestines as it dissolves more rapidly and that is preferable in these quick healing structures, as opposed to leaving foreign material, but that is the only time I ever use it. catgut is definitely my favourite for ligatures (although use vicryl in bunnies!)

RE: Use of Monocryl for Linea Closure after Abdominal Surgery

Miriam Lodewyks — Wed, 12 Jun 2019 13:21:52 GMT

I too am under the impression Monocryl's tensile strength is too short-lasting for this sort of surgery but depending on the size of the incision, depth and strength of the muscle layers you'll probably get away with it most of the time. I doubt you'd get away with it in a horse-colic...

At uni catgut was demonised, but once I got into practice I was often given little choice, and I have since become quite a fan!

RE: Use of Monocryl for Linea Closure after Abdominal Surgery

Chris Milligan — Wed, 12 Jun 2019 09:38:29 GMT

For years surgical dogma has been to use PDS or equivalent in the midline ventral abdomen - indeed I believe the VDS gave students a warning about not doing so in a talk when I was in vet school and as such it's always been my approach. However - there are many ways to skin a cat, or indeed sew it up again after you've done so, and as a locum you will undoubtedly encounted all manner of unusual ways to close this and many other types of incision. The onus is on the surgeon to do what they are comfortable with - if they've not had any problems then doubtless they will continue with what they are doing; if you're all of a sudden seeing scores of dehiscences (not sure if that's the plural) or eviscerations coming back after surgery they I'd certainly be wondering about suture choices.

A lot of preconceptions about suture materials are being challenged at the moment - at a surgical conference last year I was being coaxed by a specialist into abandoning my traditional two layer interrupted PDS closure after intestinal anastamoses in favour of the continuous single layer pattern with a far smaller gauge than I usually would select. I still haven't brought myself to do it but this thinking does change over time - as I'm sure the many people on here that have (still do?) used catgut for literally everything without apparent issue will attest to. In short I'd recommend gently discussing it with the surgeons involved and seeing what their rationale is.

RE: Use of Monocryl for Linea Closure after Abdominal Surgery

Nicola Cole — Wed, 12 Jun 2019 09:33:49 GMT

I’ve always used vicryl (in my first small animal job all we stocked was vicryl, catgut and nylon) as it’s what I’m used to so even given the option of PDS I would still normally use vicryl. However, from distant memory I‘m sure we were taught PDS for lines alba and monocryl for sub cut.