subcutaneous sutures in cats

Re: subcutaneous sutures in cats

Evelyn Barbour-Hill — Tue, 14 Sep 2010 20:04:39 GMT

[quote user="Anthony Todd"]All you geriatrics out there will nod[/quote]

Nod nod (Nodding off now )

But why are all you people using such immensely thick synthetic materials? 3/0 for a cat, nay, 2/0 for a dog ???

Re: subcutaneous sutures in cats

Anthony Todd — Tue, 14 Sep 2010 18:53:16 GMT

Mmmm, Evening surgeries are getting quieter.

Re: subcutaneous sutures in cats

Martin Jones — Tue, 14 Sep 2010 18:49:37 GMT

[quote user="Martin Atkinson"]

I undermine the end of the wound where I tie off and bury the ends in it with a pair of fine dressing forceps and I also tend to do belt and braces so put in a few interrupted mattress sutures as well but tell owners not to worry if they chew them out.

[/quote]

How about finishing with a chain knot, and then pushing the (swaged-on) needle back through the end of the wound, under the skin perpendicular to the wound, to emerge about half an inch to an inch away. Trim the suture end flush with the skin. There's a lovely little pop as the knot inverts back into the wound, and the tiny hole over the top is dabbed with a little skin glue. Seems to work very well

Re: subcutaneous sutures in cats

Martin Atkinson — Tue, 14 Sep 2010 17:58:26 GMT

[quote user="Jonathan Kirby"]

I don't think there's anything to beat Vicryl Rapide 1.5 Metric for intradermal suturing in cats and small furries too!

[/quote]

+1 for Vicryl Rapide for subcuticular sutures, 3/0 in cats and small furries, 2/0 in dogs (the boxes have 'cat' and 'dog' written on them to avoid confusion!) and have almost no reactions. I undermine the end of the wound where I tie off and bury the ends in it with a pair of fine dressing forceps and I also tend to do belt and braces so put in a few interrupted mattress sutures as well but tell owners not to worry if they chew them out.

Re: subcutaneous sutures in cats

Anthony Todd — Tue, 14 Sep 2010 17:48:07 GMT

[quote user="i am ed"]I used to prefer 2 skin sutures, because I thought if the cat removed one then the other would be backup, now I figure that's faulty logic. If the suture is loose enough I find it rare for a suture to be removed.[/quote]

Ah, at last someone's said it; the key to suture retention , not "how tight" but "how loose". the skin has to be just touching, not strangulated by a suture.

And two single interrupted 3/0 whatever with the skin opposed to full thickness so you can't see the cut. Align with the suture needle; if you can't you've done it too tight ; loosen it with your mosquitos before the cat licks/pulls/bites it out.

And if you can't get the mossies in then you've really done it far too tight!!

Sorry to teach my grandchildren to suck eggs but....

All you geriatrics out there will nod.

Re: subcutaneous sutures in cats

Jonathan Kirby — Tue, 14 Sep 2010 14:35:53 GMT

I don't think there's anything to beat Vicryl Rapide 1.5 Metric for intradermal suturing in cats and small furries too!

Re: subcutaneous sutures in cats

ilanit — Tue, 14 Sep 2010 06:19:11 GMT

[quote user="robloxley"]

Low-grade infection? - have you ever tried taking tissue sample or swabs?

[/quote]

No I haven't but it's just the typical inflammation/foreign body reaction that will go on it's own. It doesn't effect the cat, just doesn't look nice.

Surely I can't be the only one here who gets them , I have heard colleagues mention it to and according to the following paper it happens in 1/3 of cats.

http://onlinelibrary.wiley.com/doi/10.1111/j.1532-950X.1987.tb00984.x/abstract

Maybe it only happens when you operate through linea alba because I have never seen it after operations performed elsewhere

Re: subcutaneous sutures in cats

Rob Loxley — Mon, 13 Sep 2010 19:31:08 GMT

Low-grade infection? - have you ever tried taking tissue sample or swabs?

Re: subcutaneous sutures in cats

Edward Jones — Mon, 13 Sep 2010 11:12:12 GMT

Biggest revelation I had with cat spays was to use scissors instead of a blade for the approach (flank). It lets you do a tiny skin incision*, which I close with a single horizontal mattress suture (usually with gut because that's what I have closest to hand at that stage ). Instead of searching for the uterus I simply go straight for the top ovary.

I used to prefer 2 skin sutures, because I thought if the cat removed one then the other would be backup, now I figure that's faulty logic. If the suture is loose enough I find it rare for a suture to be removed. With a small incision I don't suture the fat, otherwise I frequently get a sub cut bump.

(* I know the endeavour for an ever-smaller incision site is somewhat fallacious, but it does make for a quicker stitch up and less implanted material must be better?)

Re: subcutaneous sutures in cats

plantagenet — Sun, 12 Sep 2010 22:09:36 GMT

[quote user="ilanit"] I neuter a lot of stray cats [/quote]

I do numerous rescue cats too - I use 1, occasionally 2, small mattress vicryl sutures for flank spays. Not the prettiest, but never yet had a cat get the stitches out. I don't usually take them out for strays. Pet cats get the same in nylon and I do remove them. I used to use simple interrupted but had too many need buster collars.

Re: subcutaneous sutures in cats

Anthony Todd — Sun, 12 Sep 2010 21:27:47 GMT

[quote user="Evelyn Barbour-Hill"]many Ethilon sutures go un-removed over the years and they cause no harm at all. [/quote]

Good 'ol chromic 3/0 gut stayed in quietly for months some times, we never saw C/Ss again until the millenium when we had time.

Re: subcutaneous sutures in cats

Anthony Todd — Sun, 12 Sep 2010 21:23:30 GMT

[quote user="ilanit"]So conclusion: I am a crap surgeon[/quote]

Nah, you'll be fine, you realise where the problem might be, the ones that are always crap blame their tools, materials or the animal.

There's a book Tom Yarrow quotes often [and he was a brilliant surgeon] viz;

"The difference between a good surgeon and a bad one is only 10%.....

10% quicker, 10% less trauma, 10% less haemorrhage. etc. It was called "Confessions of a Surgeon" google it, read it and take heart.

Re: subcutaneous sutures in cats

Mark Holmes — Sun, 12 Sep 2010 18:32:21 GMT

[quote user="Anthony Todd"]

[quote user="ilanit"]reactions in cats to the stitches?[/quote]

This was discussed at length in another thread. As was pointed out then catgut was used for many years in all layers with no problems when placed sympathetically.

As someone wiser than me said "Wound edges should be opposed like kissing your powdery grandmother.

Remember that and your reaction rate will plummet.

It ain't the suture it's the suture-er.[spelling?]

[/quote] If your wounds are like my Grandmother you need to get better clippers

Re: subcutaneous sutures in cats

ilanit — Sun, 12 Sep 2010 18:26:22 GMT

[quote user="Anthony Todd"]

It ain't the suture it's the suture-er.[spelling?]

[/quote]

So conclusion: I am a crap surgeon

Ok, will keep my granny in mind next time I spay a cat

Re: subcutaneous sutures in cats

Evelyn Barbour-Hill — Sun, 12 Sep 2010 17:00:25 GMT

[quote user="Anthony Todd"]As someone wiser than me said "Wound edges should be opposed like kissing your powdery grandmother.[/quote]

Nicely put!

3/0 Vicryl sounds awfully thick for anything in a cat. If you want to do Vicryl subcuticular sutures then 5/0 would be plenty strong enough.

There's more than one way to skin a cat (ha ha ) but if you are dissatisfied with your results you might try this: close the muscles in two layers with simple interrupted of 3/0 gut or 5/0 Vicryl (or 4/0 Vicryl if anxious). Don't waste time suturing fat and areolar tissue. Close the skin with simple interrupted 6/0 Ethilon - don't try to get away with as few skin sutures as possible, but on the contrary use as many as it takes. Don't leave spiky long ends. Don't use Elizabethan collars.

I can see that if you do cats that can't be returned for suture removal you have to think again: but personally I'd consider using 5/0 Vicryl or Monocryl as skin sutures then; or else continue with my usual method. I have known many Ethilon sutures go un-removed over the years and they cause no harm at all.

[quote user="Anthony Todd"]It ain't the suture it's the suture-er.[spelling?][/quote]

Wasn't there a song around in the Fifties about "It ain't watcha do, it's the way thatcha do it" ?

Re: subcutaneous sutures in cats

Anthony Todd — Sun, 12 Sep 2010 15:43:55 GMT

[quote user="ilanit"]reactions in cats to the stitches?[/quote]

This was discussed at length in another thread. As was pointed out then catgut was used for many years in all layers with no problems when placed sympathetically.

As someone wiser than me said "Wound edges should be opposed like kissing your powdery grandmother.

Remember that and your reaction rate will plummet.

It ain't the suture it's the suture-er.[spelling?]

Re: subcutaneous sutures in cats

Michael Woodhouse — Sun, 12 Sep 2010 14:24:19 GMT

[quote user="ilanit"]I use linea alba approach not flank for spays.[/quote]

Try spaying them on the flank then!

If I spay a pregnant cat some do seem to react to Vicryl midline, but never had that on the flank.

Re: subcutaneous sutures in cats

Martin Jones — Sun, 12 Sep 2010 12:23:53 GMT

If the rescue peeps are releasing them after five days, you should be able to sleep soundly without worrying about unzipping wounds. Good to be conscientious, but don't mug yourself with anxiety.

Re: subcutaneous sutures in cats

ilanit — Sun, 12 Sep 2010 11:11:22 GMT

I use linea alba approach not flank for spays. I tend to use catgut (3.0 I think?) but have also used PGA or Vicryl. I don't really notice any difference between both. I nowadays put only one horizontal mattress suture in the fat/subcutaneous just to close the hole in case they take out the outer stitches. The lump is under the skin in the fat not in the skin. I would say about 1 in 10 get it, but unfortunately a lot of cats don't come back for check up because the feeders release them in the colony after 5 days recovery.

Thanks for your input

Re: subcutaneous sutures in cats

Utlendigur — Sun, 12 Sep 2010 10:27:52 GMT

Do you mean subcutaneous (as in the fat) or subcuticular/intradermal as in the skin? Is the lump in the skin or s/c fat? I tend to use 3m catgut as a single suture in the fat (Iprefer to close the fat to provide some padding over the muscle sutures) and 3m catgut continuous subcuticular in the skin. I know catgut is old fashioned and frowned upon by some but we seem to get virtually no problems (1/vet/yr maybe? - usually suture licked out). Sometimes reaction in the s/c fat can be caused by too much suture material present rather than the material itself.

Re: subcutaneous sutures in cats

Martin Jones — Sun, 12 Sep 2010 10:03:11 GMT

(In flank spays) I use 3M vicryl in a continuous intramuscular, tied off at the top end and then continued into the skin with subcuticular / intradermal, with the merest 'dab' of skin glue (about a bottle a day). It seems to work, and the lack of anything to grab on the outside generally stops any problems. We all get the odd reaction, but no trailing guts so far.....

Re: subcutaneous sutures in cats

Louise6732 — Sun, 12 Sep 2010 09:40:49 GMT

Which size and type of material are you using? I tried (as a baby new grad) to put catgut sub-cut in a couple of spays and it was a disaster! I now use Vicryl 3-0 (I'm pretty sure it's this size, I am hopeless at remembering sizes, and go by the '9114' code on the packet!) and I haven't seen any reactions. Because the wound is so small, I find it harder not to let it get 'scrunched up' when suturing, larger wounds in general tend to close much more neatly for me.

Also, have you tried skin glue? I've never relied on it to close a wound on its own, but use it at the end of wounds/in small gaps that I'd rather not leave open.

Hope this helps!