New video: Let's Talk About Small Animal Surgery

RE: New video: Let's Talk About Small Animal Surgery

Anthony Todd — Wed, 23 Jun 2021 23:44:57 GMT

Not that it's too relevant but we always used catgut in the skin and muscle in cat spays and the skin stitch usually fell out, not that we saw ever saw the C/S routinely again.

I got into trouble when a client got irate when he represented his cat with a neat single catgut suture calmly in place some months after the op.....

I therefore don't think gut sutures are too irritant in the skin.

RE: New video: Let's Talk About Small Animal Surgery

Evelyn Barbour-Hill — Wed, 23 Jun 2021 18:34:03 GMT

[quote userid="8663" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29892/new-video-let-s-talk-about-small-animal-surgery/230903#230903"]its superiority? Except for hanging the weights in grandfather clocks [/quote]

I'm well acquainted with longcase clocks and I know the innards of mine quite intimately.

To return to surgery, though.

[quote userid="8663" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29892/new-video-let-s-talk-about-small-animal-surgery/230903#230903"]I don’t think we can agree on catgut. I simply don’t believe it’s the ligature of choice for many expert surgeons.[/quote]

Well, there's me (old guy) and Michael Woodhouse (young guy). How many more do you need? Seriously, though, we won't know unless we ask them and general practitioners are not great at responding to questionnaires.

[quote userid="8663" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29892/new-video-let-s-talk-about-small-animal-surgery/230903#230903"]Above all, do you have any scientific or technical support to illustrate its superiority? [/quote]

Er, do 49 years of using it and occasionally trying other materials count?

What are your scientific, technical and practical reasons for condemning it as "terrible"?

[quote userid="8663" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29892/new-video-let-s-talk-about-small-animal-surgery/230903#230903"]

we quite agree on monofilament nylon or polypropylene for skin sutures. In fact you could use these for almost all applications, if stuck on a desert island

I didn’t and don’t promote any fancy suture patterns. In fact I’m sure I said you can use simple continuous almost everywhere

[/quote]

I'm sorry, I didn't mean that personally, I was addressing the wider audience lurking out there. I'm not quite a fan of continuous – it seems to lead to mild distortion, I find that especially with braided material the "turns" can be of unequal tension on completion – but that may be just me. But I tell anyone who asks, and many who don't, that simple interrupted is fine for almost everything, and where it isn't then horizontal mattress is fine for very nearly everything else.

I've seen quite appalling (to me) skin suturing done by surgical authorities; and they clearly think their standard is good, as they are happy for it to be seen in video demonstations.

The trouble with studies showing that this or that or the other is better than the other that and this – be it failure of suture techniques or recovery times after endoscopic or conventional bitch spays, is that we can never tell how they compare like with like. Now if we could get surgeon Z to do 200 bitch spays, alternating conventional-approach ovariectomies with endoscopic, in as short a space of time as possible (say one year), and compare findings, we might be getting somewhere, but even then there's the possibility that Z is just not very good at conventional ovariectomy.

Then even if you can arrange to compare the results of a surgeon who's really really good at the conventional operation, and the results of one who's really really good at endoscopic (both doing their operations in the same hospital with same staff, same GA protocol, everything the same except technique), you have to consider whether the better figures are really of importance – 8 hours for some parameter of recovery would be importantly better than ten days, but would it be importantly better than 12 hours?

[quote userid="8663" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29892/new-video-let-s-talk-about-small-animal-surgery/230903#230903"]your dig at eminence based medicine seems odd, given your own bias to catgut! [/quote]

I genuinely have no idea what you mean.

RE: New video: Let's Talk About Small Animal Surgery

Alasdair Hotston Moore — Tue, 22 Jun 2021 17:31:15 GMT

Vetafil and similar are still around. They knit secure,y but do cause more mechanical irritation and inflammation than monofilaments. They are pseudomonofilament or sheathed braided materials.
of course you’re correct that a single knit failure could lead to failure of a simple continuous pattern, but studies have shown no greater failure than simple interrupted. I think this could be because even if only one SI falls, the rest might unzip too

RE: New video: Let's Talk About Small Animal Surgery

Anthony Todd — Tue, 22 Jun 2021 17:20:03 GMT

What happened to Vetafil, the white stuff on a reel and easy to knot too?

I was always scared, and have seen, the end single knot in a continuous line fail and the whole thing came apart [BSpay]

RE: New video: Let's Talk About Small Animal Surgery

Alasdair Hotston Moore — Tue, 22 Jun 2021 17:04:56 GMT

I don’t think we can agree on catgut. I simply don’t believe it’s the ligature of choice for many expert surgeons. Above all, do you have any scientific or technical support to illustrate its superiority? Except for hanging the weights in grandfather clocks

we quite agree on monofilament nylon or polypropylene for skin sutures. In fact you could use these for almost all applications, if stuck on a desert island

I didn’t and don’t promote any fancy suture patterns. In fact I’m sure I said you can use simple continuous almost everywhere

your dig at eminence based medicine seems odd, given your own bias to catgut!

RE: New video: Let's Talk About Small Animal Surgery

Evelyn Barbour-Hill — Tue, 22 Jun 2021 16:24:10 GMT

"Catgut is a terrible ligature material"

Catgut is an excellent ligature material. It knots securely and doesn't come off (assuming it's competently applied). It retains its strength for as long as anyone could want a ligature to retain strength. Properly used, on balance it is superior to any suggested alternatives. It is still the ligature material of choice for some (many?) expert surgeons.

Monofilament nylon and polypropylene both provide all one could desire in a skin suture. (I can't see any difference in their characteristics, but I keep both in order to have the various needle configurations I like.) Where people go wrong with them – and are being taught to do, and are teaching others to do – is to use far too heavy a gauge. Dogs' skin never requires anything thicker than 4/0, and 5/0 is fine in many situations. For cats it's 5/0 or 6/0.

Use fancy suture patterns if you like but most of them are quite unnecessary. And cut the ends short! Why do people leave them so long? No wonder they irritate the patient.

Alas, the pernicious effect of eminence-based medicine. For suturing anything intra-oral in cat or dog, 6/0 is generally all you need; 5/0 is indicated in some situations. Yet the eminencies and "authorities" of veterinary dental surgery of the USA are still advocating and teaching the use of 4/0, 3/0, even 2/0. I once went on a practical course where, er, a well-known cosmopolitan lecturer was teaching advanced oral surgery. We were only provided with 2/0 Prolene for practising. I said to him "what would you suggest in real life for the gingiva? Monocryl? 5/0, 6/0?" "Oh no," he said, "5/0 would be much too fine". I left it at that and didn't tell him I'd been successfully suturing anything intra-oral with 6/0 Monocryl or (shock horror) Vicryl for about ten years.

RE: New video: Let's Talk About Small Animal Surgery

Bob Russell — Tue, 22 Jun 2021 14:09:49 GMT

Anderson Moores seem to have cancelled our patients booked in for treatment. Apparently something to do with stuff stuck in Germany.

RE: New video: Let's Talk About Small Animal Surgery

Kate Richardson — Tue, 22 Jun 2021 09:30:48 GMT

You too!!

RE: New video: Let's Talk About Small Animal Surgery

Alasdair Hotston Moore — Tue, 22 Jun 2021 06:26:35 GMT

We’ve nothing to disagree on then ! Have a good day

RE: New video: Let's Talk About Small Animal Surgery

Kate Richardson — Mon, 21 Jun 2021 10:07:11 GMT

[quote userid="8663" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29892/new-video-let-s-talk-about-small-animal-surgery/230889#230889"]I do thyroidectomies. But I do think I-131 is better.[/quote]

I agree. I don't think there's any argument that I-131 is a better treatment option when you look at outcomes. But a thyroidectomy or medical management are better treatment options in some cats for different reasons. And we have to consider costs as a reason, thats just reality. But there are many other factors and these are equally as important, sometimes more so and I think the profession is starting to forget that a good outcome isn't just about how long the animal lives for after treatment. And if specialists put down a treatment option, then many animals may miss out on a great treatment option as a myth starts to get perpetuated that that option is bad. I use all options available to me and together we decide which is the best option for this cat and this owner.

RE: New video: Let's Talk About Small Animal Surgery

Alasdair Hotston Moore — Sun, 20 Jun 2021 14:40:44 GMT

[quote userid="6386" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29892/new-video-let-s-talk-about-small-animal-surgery/230879#230879"]And against thyroidectomies. It’s a perfectly valid treatment for many cats. Even if radio iodine was cheap as chips 3 weeks confinement is not appropriate for some cats.[/quote]

I do thyroidectomies. But I do think I-131 is better.

From the AAFP guidelines on hypertrophy 2016:

Radioactive iodine
Experts generally agree that radioiodine is the treatment of choice for most cats with FHT. The distinct advantages of ¹³¹I treatment include…..

RE: New video: Let's Talk About Small Animal Surgery

Alasdair Hotston Moore — Sun, 20 Jun 2021 14:36:32 GMT

[quote userid="3169" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29892/new-video-let-s-talk-about-small-animal-surgery/230884#230884"]

Would be a very sad day when i have to use anything else for ovarian pedicles in dogs. Nothing comes close for uterine and muscle closure in cattle (to 8 metric catgut), and I've tried literally everything.

(I also contend that my bitch spays are as bright and bouncy when they go home as when they arrive!)

[/quote]

It’s your choice and your experiences. But published evidence shows a difference in outcome of lap spays. And few specialists favour catgut in small animals. It’s a long time since a did a cow CS

RE: New video: Let's Talk About Small Animal Surgery

Alasdair Hotston Moore — Sun, 20 Jun 2021 14:34:32 GMT

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29892/new-video-let-s-talk-about-small-animal-surgery/230885#230885"]Nylon is a horrible suture material! Even worse in the prepuce![/quote]

Prepuce is an unusual site to suture. Monofilament nylon requires care to use well but is the choice of most of us focussing on surgery

RE: New video: Let's Talk About Small Animal Surgery

Alasdair Hotston Moore — Sun, 20 Jun 2021 14:32:06 GMT

Always happy to make surgeons think. We may not agree but we can discuss

RE: New video: Let's Talk About Small Animal Surgery

Anthony Todd — Sun, 20 Jun 2021 12:56:12 GMT

Nylon is a horrible suture material! Even worse in the prepuce!

[Hides in nuclear bunker]

RE: New video: Let's Talk About Small Animal Surgery

Michael Woodhouse — Sun, 20 Jun 2021 01:45:35 GMT

[quote userid="2131" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29892/new-video-let-s-talk-about-small-animal-surgery/230834#230834"]A pity to see the prejudice against catgut as a ligature material. Catgut is an excellent ligature material.[/quote]

Agree 100%. Would be a very sad day when i have to use anything else for ovarian pedicles in dogs. Nothing comes close for uterine and muscle closure in cattle (to 8 metric catgut), and I've tried literally everything.

(I also contend that my bitch spays are as bright and bouncy when they go home as when they arrive!)

RE: New video: Let's Talk About Small Animal Surgery

Kate Richardson — Sat, 19 Jun 2021 09:35:13 GMT

[quote userid="2131" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29892/new-video-let-s-talk-about-small-animal-surgery/230834#230834"]

A pity to see the prejudice against catgut as a ligature material. Catgut is an excellent ligature material.

I don't suppose that is the sort of opinion you were looking for.

[/quote]

And against thyroidectomies. It’s a perfectly valid treatment for many cats. Even if radio iodine was cheap as chips 3 weeks confinement is not appropriate for some cats.

RE: New video: Let's Talk About Small Animal Surgery

Arlo Guthrie — Thu, 17 Jun 2021 14:32:00 GMT

[quote userid="2131" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29892/new-video-let-s-talk-about-small-animal-surgery/230834#230834"]I don't suppose that is the sort of opinion you were looking for.[/quote]

Laughed out loud. Actually, I don't mind in the slightest. The thing that matters to me is above all whether we're producing interesting content. I don't mind if people have different opinions!

RE: New video: Let's Talk About Small Animal Surgery

Evelyn Barbour-Hill — Thu, 17 Jun 2021 14:18:49 GMT

A pity to see the prejudice against catgut as a ligature material. Catgut is an excellent ligature material.

I don't suppose that is the sort of opinion you were looking for.

[quote userid="2100" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29892/new-video-let-s-talk-about-small-animal-surgery"]on the whole I thought it was a really engaging format (so much more so than staring at a powerpoint for days on end!) and the result is, I would like to think, a really practical form of information-sharing. [/quote]

I agree.

RE: New video: Let's Talk About Small Animal Surgery

Gillian Mostyn — Thu, 17 Jun 2021 09:52:21 GMT

I did find it interesting - thanks!

And you've just reminded me that I haven't logged it on my CPD record.