Suture material?

RE: Suture material?

Bob Russell — Sat, 18 Sep 2021 09:57:11 GMT

VDS will defend anyone doing anything. The difference is how much effort will be put in before paying up.

As with anaesthetics the safest suture material is the one the surgeon is most used to/comfortable with. I use a lot of polysorb and do midlines with PDS despite the fact I dislike how it handles. I sleep at night!!

I transfix the ovarian pedicle and have 'shoved the needle through the blood vessel on more than one occasion. The bleeding stops when the ligature is tightened and/or the second ligature stops further bleeding. My philosophy is that if there is going to be bleeding I would prefer it to be when I am there to stop it. Others don't transfix and have no problems either.

There are no rights or wrongs.

RE: Suture material?

Anthony Dennison — Fri, 17 Sep 2021 14:41:33 GMT

[quote userid="11590" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29962/suture-material/232596#232596"]I've read and heard quite a few comments saying the VDS would not support someone if they used a certain suture material/knot or do a certain thing. One recent comment was from a locum I worked with who said the VDS would not support (I assume this mean would not defend and so would pay out) someone who did not use a transfixing ligature on an ovarian pedicle during a bitch spay. I have never in my 16 years used a transfixing ligature on an ovarian pedicle and (so far) I have never had a post spay bleed. It was interesting to get such an opinion from someone else but I didn't believe them. It then makes me wonder what we base these ideas on.[/quote]

This is an old wives tale, and not true. I agree, I'd never use a transfixing ligature on an ovarian pedicle. Shoving a needle through without clearly being able to visualise the vessel you're trying to avoid? Nope.

Single encircling ligatures on ovaries and cervix for me, may put a transfixing on the cervix if it's particularly juicy (caesar-spay) or if there is a bit of oozing. No major issues in almost a decade.

RE: Suture material?

George Cooper — Sat, 28 Aug 2021 12:57:11 GMT

Years ago I think when Vicryl was becoming more used in veterinary surgery, I had a longish introduction to using it from the regional Ethicon rep. According to her there was no need to knot the material, simply to lay it in the tissues and Bob's your Uncle.

The fact that it seemed "rougher" was what allowed it to stay put. There was a bit of an issue with little blebs, or blisters forming, usually over the site of the knot, and erupting 6-8 weeks after the operation. This was due, she said, to "blanching" of the tissues - i.e. user error in attempting to be too tight.

Rarely did we see untoward concerns with it, other than very rare blister formation - which once it burst would heal in days.

RE: Suture material?

cairncross — Fri, 27 Aug 2021 23:04:56 GMT

This has all been my experience to , I get on better with Polysorb than vicryl actually ? do I naturally use a little to much tension? Polysorb seems smoother . In 20 years I have never had anyone around me with experience of PDS to direct me on this bought a box and abandoned the first packet as was quite unsure of myself with it.

RE: Suture material?

Julian Earl — Fri, 27 Aug 2021 18:10:36 GMT

oke Clive, I rarelif ever transfixed any ligature. I felt that catgut was non-slippy enough when pulled tight around s cervicsl stump it was always secure. For ovarian stump, even les becessary I tink AsI write I can recall some scary big arterieson eg apyometra or si milar engorgeuteus where

i lostmy nerve and transfixed a ligature aound such a vessel with catgut or occasionally Vicryl. Yhis last does seem particularly securebeing rough and so grips well in the nots pludcan be very fine so theholes are smaller. It does sometimes seem to pose the risk of a cheese-wire effect though when tightened. Luckily I don't think that ever really happened to me. For the muscle/Linea Alba PDS has no equal! Smooth, swged on to the needle, non-abrasive, non-antigenic, not eally anyeeway, slow to dissolve and secure knots. Very, very few problems ever. A bit expensive but so whatif the result is better?? Thanks...

RE: Suture material?

Clive Ansell — Fri, 27 Aug 2021 17:58:23 GMT

We were taught at university (RCVS diploma holder and recognised specialist surgeon) that catgut is the product of Satan and has 666 embossed on the packaging somewhere.

Personally, I don't like catgut and prefer synthetic absorbables, but I know many who use it regularly, like it, and have no problems with it. Personal preference I guess. Usual veterinary profession dogma?

[quote userid="6765" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29962/suture-material/232623#232623"]I have never transfixed ovarian ligatures but always do so at cervix, except in kittens.[/quote]

I transfix ovarian ligatures in large or fatty dogs, or if the pedicle is thick or fatty, but usually not. I don't usually transfix the cervical ligature in cat, unless a large or in season uterus. I do in dogs unless very small (cat size) or pre season. I have had one case in 25 years of a post operative bleed from a poor ligature, that I am aware of.

[quote userid="6765" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29962/suture-material/232623#232623"]Used catgut in the old days but PDS for most things now.[/quote]

Rarely use PDS, usually Vicryl, for routine neuters etc. Will use it older patients or where I feel healing may be slower or compromised.

RE: Suture material?

Alistair Graham-Evans — Wed, 25 Aug 2021 21:11:07 GMT

I have never transfixed ovarian ligatures but always do so at cervix, except in kittens.

Used catgut in the old days but PDS for most things now.

RE: Suture material?

Anthony Todd — Wed, 25 Aug 2021 16:42:25 GMT

Yes sorry, you are, of course right!#

But would it stop a dodgy ligature and I think I remember someone saying that the difficulty was not penetrating the artery while so doing?

RE: Suture material?

Bibs — Wed, 25 Aug 2021 16:40:08 GMT

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29962/suture-material/232613#232613"]Actually, thinking about it! Why would anyone want, or need, to transfix a ligature of a largish pulsating artery to a moving abdominal wall, let alone one[/quote]

They meant that the ligature should passed through the pedicle as well as around it rather than just be tied around it.

RE: Suture material?

Anthony Todd — Wed, 25 Aug 2021 16:33:22 GMT

[quote userid="7269" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29962/suture-material/232611#232611"] everyone has to transfix an ovarian pedicle is, quite frankly, daft. [/quote]

Actually, thinking about it! Why would anyone want, or need, to transfix a ligature of a largish pulsating artery to a moving abdominal wall, let alone one

that is moving regularly with respiration and is/was some distance from a convenient anchoring point?

Anyone EVER seen catgut break? Mine [hardly ever, [but yes he honest??] all the bloody knots had "untied" and the catgut looked pristine!

RE: Suture material?

Joyce Whitehead — Wed, 25 Aug 2021 16:09:16 GMT

I agree with Evelyn, I think if you use the right size of catgut it is perfectly strong. I used it for bitch spay pedicels for years, and didn’t notice too many reactions in bitches we opened up again for any reason.

I’m also fairly sure that I’ve seen statements from VDS saying that they will never “not defend” someone, they might gently suggest you didn’t use the most effective technique but to say everyone has to transfix an ovarian pedicle is, quite frankly, daft.

RE: Suture material?

Evelyn Barbour-Hill — Wed, 25 Aug 2021 15:45:23 GMT

[quote userid="2122" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29962/suture-material/232598#232598"]Abandoned catgut completely after seeing the adhesions internally when we had to exlap a bitch who had had catgut ligatures. Horrendous (possibly) stuff with low tensile strength and the unparalleled ability to create reactions.[/quote]

Apologies for turboposting but I can't multi-quote from one page to another.

George, I'm sorry but I have to take issue with such statements.

"Low tensile strength" is not right. Yes, size for size, most synthetic sutures are stronger than catgut. Or, as we saw it on first discovering Vicryl – "if you use Vicryl you can go down a size or even two".

Catgut induces an inflammatory reaction, of course it does, that's what makes it absorbable. Before the advent of synthetic absorbables (Dexon was the first, I think, in about 1974) we didn't know that a material could be absorbable by hydrolysis. That doesn't mean the reaction will be severe or unacceptable, unless the material is unsterile or you've made horrible lumpy knots.

You can get inflammation and adhesions round Vicryl too. Or nylon for that matter.

RE: Suture material?

Anthony Todd — Wed, 25 Aug 2021 15:13:27 GMT

Strange and not my, and others', experience at all EXCEPT it could "untie" in midline closures but was it the material or the operator??

AFAIK we never secured the ovary tie-off in bitches or queens and, as the ovary etc was expetiorised it, seemed an added pfaff??

Unless you enlarged the incision wouldn't the tie of point be distal to the ovary tie off??

PS, why would you?? where the logic, probably adds to the tension on the ligament, and certainly adds to the op. as the ligament has been exteriorised.

My first boss, "Uncle Clive" used boiled cotton on a metal thermometer case and never seemed to have trouble.

Go figure!

RE: Suture material?

Evelyn Barbour-Hill — Wed, 25 Aug 2021 15:05:43 GMT

[quote userid="5904" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29962/suture-material/232560#232560"]What was wrong with Vetafil for skin closures [only!]?[/quote]

Anthony, this thread is about catgut used internally and not about skin sutures*

However, your question is a good one and it's time skin sutures were debated, so I'm going to start a tangent from your post, after I have dealt with this thread.

*( In my first practice in 1972, we closed the skin on cat spays with one clunky suture of catgut. The owners were told "the stitch will dissolve and the cat will take it out herself". It worked, although it made for a horrid scar. Not a good thing, but common practice. I think it just illustrates the way cats were seen, by both he veterinary profession and by owners, in those days).

RE: Suture material?

George Cooper — Wed, 25 Aug 2021 12:35:51 GMT

Abandoned catgut completely after seeing the adhesions internally when we had to exlap a bitch who had had catgut ligatures. Horrendous (possibly) stuff with low tensile strength and the unparalleled ability to create reactions.

Vicryl rules OK?

RE: Suture material?

Anthony Todd — Wed, 25 Aug 2021 12:04:06 GMT

[quote userid="11590" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29962/suture-material/232596#232596"]I have never in my 16 years used a transfixing ligatu[/quote]

Nor me, and I don't think anyone I know. but it's probably buried in vetdogma so is obviously true. Try corticosteroids in rabbits for the best example.

RE: Suture material?

Bibs — Wed, 25 Aug 2021 11:41:59 GMT

I've read and heard quite a few comments saying the VDS would not support someone if they used a certain suture material/knot or do a certain thing. One recent comment was from a locum I worked with who said the VDS would not support (I assume this mean would not defend and so would pay out) someone who did not use a transfixing ligature on an ovarian pedicle during a bitch spay. I have never in my 16 years used a transfixing ligature on an ovarian pedicle and (so far) I have never had a post spay bleed. It was interesting to get such an opinion from someone else but I didn't believe them. It then makes me wonder what we base these ideas on. Is it assumption based on what we think most people consider appropriate or is it something more concrete? I'd actually like to know more about how judgements are made re appropriate treatment either by the VDS or RCVS. Is it just as long as you do what most other people would do? Maybe this should be a tangent.

RE: Suture material?

Thomas Johnson — Wed, 25 Aug 2021 09:47:42 GMT

[quote userid="6765" url="~/001/veterinary-clinical/small-animal/soft-tissue-surgery/f/discussions/29962/suture-material/232570#232570"]I can see no use for it today. Rapid loss of strength and inflammatory reaction. Not even sure VDS would support you in the event of a wound breakdown. [/quote]

I'm not sure what you mean by this? If you mean that they wouldn't defend your action as reasonable I think you may be right, but I think they would accept liability and pay out for any treatment needed to correct the problem.

I agree with not using it to close wounds though, I prefer PDS in the linea alba and use Vicryl for everything else in a bitch spay, though I have colleagues who use catgut to tie ligatures and I've never seen any problems with it being used for this.

RE: Suture material?

Dinu Catilina — Wed, 25 Aug 2021 06:43:11 GMT

I used loads of Chromic catgut to close abdominal incisions in Romania at a time when the alternative was spirit soaked fishing line. I only remember one dehiscence but I believe it was the knot and not the suture. Never used it in the UK though since everyone around me was horrified at even speaking about it. I do believe PDS has multiple theoretical advantages.

RE: Suture material?

Alistair Graham-Evans — Tue, 24 Aug 2021 21:09:06 GMT

I can see no use for it today. Rapid loss of strength and inflammatory reaction. Not even sure VDS would support you in the event of a wound breakdown.

RE: Suture material?

Joyce Whitehead — Tue, 24 Aug 2021 16:53:37 GMT

I also still like catgut and use it for cat spays still. Including closure. I don’t use it in dog suturing but use it as a ligature for instance in mass removals, mammary strip etc. I’ve definitely seen a dog with an abdominal wound breakdown with not thick enough catgut in the muscle (this was many years ago). We were always taught not to use it for abdominal muscle closure even in the late 70s/early 80s

RE: Suture material?

Anthony Todd — Tue, 24 Aug 2021 16:32:42 GMT

What was wrong with Vetafil for skin closures [only!]?

PS Any skin suture with any material will cause a "wound infection" if pulled too tight!

RE: Suture material?

Evelyn Barbour-Hill — Tue, 24 Aug 2021 15:39:35 GMT

Catgut is still the best ligature material (for cat, dog or horse).

I have closed many many midline abdominal incisions in dog and cat with catgut with no breakdowns. I moved to Vicryl a long time ago because it has considerable advantages. Catgut does have disadvantages but wound breakdown is not one of them when the suturing is competently done.

RE: Suture material?

Lucy Fleming — Tue, 24 Aug 2021 14:34:25 GMT

I still use it in cats and dogs for ligatures (bunnies I use vicryl) but not for closing anything. I keep thinking I should move away from it completely but it appears I'm not going to stir myself to unless forced! (Though FWIW, I've never come across a case that I've either known or expected to have a cat gut granuloma causing any of their clinical signs, though I'm not trying to suggest that they don't exist)

RE: Suturematerial?

Bibs — Tue, 24 Aug 2021 13:01:26 GMT

Early in my career I used it a lot for all ligatures and for closing flank cat spays but never midlines or for closing anything else. Now I don't use it for anything because I had a couple of years away and came back to a practice that didn't keep it. There is a lot of concern about tissue reactions and unreliable duration of strength. I have heard some stories about midline wounds falling apart after people using catgut to close and would not trust it to maintain its strength in this type of wound personally.