Complications associated with closure of the linea alba using a combination of interrupted vertical mattress and simple interrupted sutures in equine laparotomies.

OBJECTIVES: (1) Evaluate the occurrence and variables associated with incisional morbidities (IMs) after ventral median laparotomy when using interrupted vertical mattress sutures (IVMS) and (2) determine the occurrence of abdominal bandage-associated complications in horses. METHODS: Occurrence of IM and bandage-associated complications were determined after single laparotomies (SL group; n=546 horses) and repeat laparotomies (RL group: multiple laparotomies within four weeks; n=30 horses) in horses that survived ≥7 days postoperatively. Univariate analysis and multivariate logistic regression were performed to evaluate variables associated with IM. RESULTS: The IM rate was 9.52 per cent in the SL group and 33.33 per cent in the RL group. The actual infection rate was 5.31 per cent in the SL group and 26.67 per cent in the RL group. Overall, long-term clinically relevant wound complications was 1.68 per cent. After multivariate analysis, increased anaesthesia duration was associated with IM and performing an enterotomy and postoperative intravenous lidocaine administration were associated with incisional infection in the SL group; no parameter remained significant in the RL group. Bandage-related complications were recorded in 2.95 per cent of the cases. CONCLUSIONS: These results suggest that the use of IVMS for closure of the linea alba is another viable option for closure and that an abdominal bandage does not appear to cause significant complications.

Suture length to wound length ratio in 175 small animal abdominal midline closures.

Experimental and human studies have reported the advantages of a suture length to wound length (SL:WL) ratio greater than 4:1 in midline abdominal closure. This is achieved when the tissue bite (TB) is equal to or larger than the stitch interval (SI). Although TB and SI values are recommended in some textbooks, SL:WL ratios are rarely reported in veterinary textbooks. Additionally, no clinical data regarding these parameters could be found in small animals. Therefore, the aim of this study was to evaluate the SL:WL ratio of midline laparotomy closure in dogs and cats performed by surgeons with different levels of expertise and to compare the findings with current textbook recommendations. Midline laparotomy incisions of 100 dogs and 75 cats were closed in continuous pattern by diplomates and residents of both the European College of Veterinary Surgeons (ECVS) and the European College of Animal Reproduction (ECAR). The mean SL:WL ratio was 2.5 ± 0.7:1. The surgeons´ level of experience and the species and body weights of the animals did not have any significant influence on the SL:WL ratio. A moderate negative correlation was observed between the mean SI to mean TB (SI:TB) ratio and the SL:WL ratio. In this study, the mean SI matched the textbook recommendations both in feline and canine species, whereas the TB in cats was different. In this study, the SL:WL ratio was less than 4:1 without apparent complications. Because of the low prevalence of incisional hernia in dogs and cats larger studies are necessary to evaluate clinical significance of the presented data.

Suture length to wound length ratio for simple continuous abdominal closures in veterinary surgery: An experimental in vitro study.

OBJECTIVE: This study aimed to investigate the suture length to wound length ratio (SL:WL) in an in vitro model of abdominal wall closure. Effects of the surgeon's experience level on the SL:WL ratio were evaluated, hypothesizing that small animal surgeons do not spontaneously apply SL:WL ratios equal to or larger than 4:1. PROCEDURES: Three groups of surgeons with varying levels of experience performed 4 simple continuous sutures before (3 sutures) and after (1 suture) being educated on principles of the SL:WL ratio. All sutures were evaluated for their gaping, number of stitches, stitch intervals, tissue bite size and suture length. RESULTS: No significant differences in suture parameters or SL:WL ratios were found among the 3 groups, and 60.5% of control sutures and 77.0% of test sutures had SL:WL ratios above 4:1. There was a significant improvement in the mean ratio after the information was provided (p = 0.003). Overall, the SL:WL ratios ranged from 1.54:1 to 6.81:1, with 36.3% falling between 4:1 and 5:1 (5.17 mm mean stitch interval, 5.52 mm mean tissue bite size). A significant negative correlation was observed between the SL:WL ratio and the stitch interval to tissue bite ratio (r = -0.886). Forty-nine of 120 sutures fulfilled the current recommendations for abdominal wall closure with a mean SL:WL ratio of 4.1:1. CONCLUSION: A SL:WL ratio larger than 4:1 was achieved in 60% of the control sutures and in 77% of test sutures. Additional animal studies are necessary to evaluate the SL/WL ratio in small animal surgery.

Biomechanical analysis of unidirectional knotless suture loop weld integrity after passage through a cadaveric body wall.

OBJECTIVE: To evaluate the integrity of the welded end loop on unidirectional knotless suture after transabdominal passage in a canine cadaver. STUDY DESIGN: Ex vivo biomechanical study. STUDY POPULATION: Four variations of unidirectional knotless suture and 1 canine cadaver. METHODS: Welded end loop on strands consisted of 0 Quill polydioxanone (QP; n = 22), 0 Quill monoderm (QM; n = 23), 2-0 V-Loc 90 (V9; n = 12), and 2-0 V-Loc 180 (V18; n = 12). Half of the suture strands in each group were passed percutaneously through an insufflated cadaveric body wall, and the remaining half served as intact controls. A linear testing machine was used to load the sutures to failure. Modes of and loads to failure were compared within and between suture types. RESULTS: Loads to failure did not differ between sutures passed through the body wall and their controls when the loop remained intact. Sutures V9, V18, and QM sustained higher loads to failure compared with QP. All Quill suture lines failed at the weld during testing. Thirty-three percent of QP sutures failed at the weld during initial passage through the body wall. V-Loc sutures failed at the suture-apparatus interface, within the welded loop, or a combination. CONCLUSION: Passing suture through a cadaveric body wall did not affect the integrity of the welded end loop of any of the unidirectional knotless sutures tested here when the loop remained intact. CLINICAL SIGNIFICANCE: Unidirectional knotless suture (V9, V18 and QM) can be safely passed through a canine body wall for use in laparoscopic procedures. The use of QP in this manner cannot be recommended.

Bursting strength of surgeon's and self-locking knots for closure of ventral midline celiotomy in horses.

OBJECTIVE: To compare the bursting strength and failure mode of ventral midline celiotomy closed with a simple continuous suture pattern with 1 of 2 knot combinations, a novel self-locking knot combination of a forwarder start with an Aberdeen end knot (F-A) and a traditional combination of a surgeon's start with a surgeon's end knot (S-S). STUDY DESIGN: Ex vivo experimental. SAMPLE POPULATION: Equine cadavers (n = 14). METHODS: A 20-cm ventral midline celiotomy was created in 14 equine cadavers. Horses were assigned to celiotomy closure with an F-A or S-S knot combination. Prior to closure, a 200-L inflatable bladder was placed in the abdomen and then insufflated until failure of the celiotomy closure. The horses' signalment, weight, breed, and age, as well as knot combination type, mode of failure, closure time, and bursting strength (mm Hg) were recorded. RESULTS: The median bursting strength was significantly greater when incisions were closed with the F-A knot combination (388 mm Hg) compared with the S-S knot combination (290 mm Hg) (P = .035). Most incisions failed along the fascia when closed with F-A combinations and at the knot when closed with S-S combinations. CONCLUSION: The bursting strength of ventral midline incisions in equine cadavers was increased by an average of 25% when closed with the self-locking F-A knot combination. CLINICAL SIGNIFICANCE: Closing ventral midline celiotomies with an F-A knot combination may provide a more secure closure than the traditional S-S knot combination. Additional in vivo investigation is required prior to recommending this closure in clinical cases.

Biomechanical properties of celiotomy wounds closed with tape and cyanoacrylate versus intradermal sutures.

OBJECTIVE: To compare cutaneous wound closure with mesh and 2-octyl cyanoacrylate (MOC) vs an intradermal suture pattern (ISP) in terms of time of application and biomechanical properties. SAMPLE POPULATION: Experimental study with 12 female beagle dogs. METHODS: A skin incision was created from the xiphoid to the pubis as part of an ovariohysterectomy; the linea alba and subcutaneous tissue were closed routinely. Half of the skin incision was closed with MOC, and the other half was closed with an ISP. Tissue samples were collected from both sections at days 14 and 28 and tested for ultimate strength and stiffness. RESULTS: Closure with MOC (72.8 ± 14.0 s) was faster than with an ISP (398.4 ± 36.4 s; P = .001). The ultimate load and stiffness increased with time for MOC (P = .005 and P = .005, respectively) and ISP (P < .001 and P < .001, respectively). On day 14, ultimate load and stiffness were greater in wounds closed with MOC compared with ISP (P = .014 and P = .02, respectively). No difference between groups was detected at day 28. CONCLUSION: Cutaneous wound closure with MOC was faster and resulted in superior strength at 14 days compared with closure with an ISP in this healthy population. CLINICAL SIGNIFICANCE: Mesh and 2-octyl cyanoacrylate offers an attractive alternative to ISP for skin closure after celiotomy in dogs, especially if surgical/anesthesia time is a concern.

Influence of 2 Veress needles and 4 insertion sites on Veress needle penetration depth: A comparative study in cadaveric dogs.

OBJECTIVE: To evaluate the penetration depth (VNPD) of 2 disposable Veress needles (VN) at 4 insertion sites in the abdomen. STUDY DESIGN: Descriptive study. SAMPLE POPULATION: Canine cadavers (n = 22, 6 for confirmation of the test methods and 16 for the comparative study). METHODS: Two disposable VN (VN A and VN B) were inserted at 4 sites (9th intercostal space [ICS] and preumbilical, paraumbilical, and subumbilical sites) in dorsally recumbent dogs by using a hand-cranked jig. The VNPD was measured as the distance traveled by the VN between the subcutaneous tissue and the perforation of the peritoneum on the basis of audible clicks and visible feedback from the VN. The effects of the VN type and insertion site on the VNPD were analyzed by using a linear mixed-effects model. RESULTS: VNPD varied between insertion sites (P = .01) and VN (P < .01). The VNPD was less at the 9th ICS than at the preumbilical, paraumbilical, and subumbilical sites. The maximal magnitude of change was 7.4 mm. Veress needle B (with a low spring rate, lower forces, and a back-cut bevel design) penetrated farther than VN A (with a high spring rate, high forces, and a lancet-type bevel) at 3 of 4 insertion sites. The maximal magnitude of change was 6.8 mm. CONCLUSION: Veress needle penetration depth varied between VN designs but was the least at the 9th ICS in canine cadavers. CLINICAL SIGNIFICANCE: Insertion of a VN at the 9th ICS is recommended to minimize its penetration into the abdomen. Associations between VNPD and mechanical factors, such as the sharpness and spring rate of VN, warrant additional research.

Comparison of incisional bursting strength of 2-strand continuous crossing and simple continuous patterns for closure of the equine linea alba.

The objective of this study was to assess and compare the bursting pressure and mode of failure of a 2-strand continuous crossing suture pattern and a simple continuous suture pattern for closure of the equine linea alba. No difference in bursting strength or mode of failure was found between the 2 suture patterns.

Comparaison de la force d'éclatement des incisions des sutures simples continues et des sutures croisées continues à deux fils pour la fermeture de la linea alba des équidés. Cette étude avait pour objectif d'évaluer et de comparer la pression d'éclatement et le mode d'échec d'un type de suture croisée continue à deux fils et d'un type de suture simple continue pour la fermeture de la linea alba des équidés. Aucune différence de force d'éclatement ou de mode d'échec n'a été constatée entre les deux types de suture.(Traduit par Isabelle Vallières).

Surgical treatment of traumatic eventration with polyester button and polypropylene mesh to strengthen the suture technique in equine.

BACKGROUND: Defects in the abdominal wall of horses have high relapse rate. This is mainly in lateral eventrations and hernias caused by trauma from kicks of other horses or installation structures. The eventration region normally becomes swollen and there may be complications due to intestinal loop incarceration. The surgical treatment, consisting of reconstruction of the abdominal wall, frequently require biological or synthetic materials for the reinforcement of the suture line and tension support. Therefore, several studies have reported new materials for the repair of the abdominal wall, with the aim of improving the integration among adjacent tissues and reducing risks and complications such as rejection and infection. This report describes for the first time the use of a regular polypropylene mesh reinforced with polyester buttons for the herniorrhaphy. CASE PRESENTATION: A male, three-year-old, Appaloosa with 500 Kg presented to our hospital with a 10 days history of an increased volume on the left ventro-lateral region of the abdomen. During the physical examination, a deventration following traumatic rupture of the abdominal wall was diagnosed via ultrasonography. Then, the equine was anesthetized and moved to surgery for correction of the eventration which was performed according to conventional technique described in literature. Two days later, an eventration relapse was observed and confirmed via ultrasonography. After that, a second surgical intervention was performed using polyester buttons and polypropylene mesh. After the second surgical procedure, no complications related to eventration were observed either intra or postoperatively. After that, a recheck was performed thirty days later where satisfactory wound healing and total recovery were observed. CONCLUSION: The use of polypropylene mesh reinforced with polyester buttons is an effective technique for the repair of traumatic eventration in horses. This technique provides effective reinforcement against the abdominal tension and was a good option for reconstruction of lacerated muscles in cases of equine post-traumatic eventration, including relapsing cases.

Negative pressure wound therapy with instillation for body wall reconstruction using an artificial mesh in a Dachshund.

CASE REPORT: A 4-year-old spayed female Dachshund was presented in shock, displaying multiple haematomas and puncture wounds along the left abdominal wall and ventral aspect of the abdomen after being attacked by another dog. A defect of the left lateral body wall was palpated. Surgery revealed a massive body wall defect and concurrent injury of the intestines. Surgical debridement was performed and the injured portion of the jejunum was resected. The abdominal wall was reconstructed using a polypropylene mesh. Negative pressure wound therapy (NPWT) with instillation of 0.04% polyhexanide (-125 mmHg, instillation interval of 2 h, duration 20 min) was started. Microbial culture after reconstruction of the defect and before application of the NPWTi dressing revealed multiresistant Staphylococcus pseudintermedius. The NPWT dressing was changed on days 2, 5 and 7. Microbial cultures obtained at the first two dressing changes were negative. Therapy was well tolerated and the mesh was completely covered by granulation tissue after 10 days, when the wound was surgically closed. CONCLUSION: Bite wounds frequently result in massive, contaminated defects with impaired perfusion, and reconstruction using foreign material carries the risk of biofilm formation and infection. Instillation therapy may provide an alternative for bacterial clearance and fast integration of the mesh.

Comparison of tensile strength and early healing of acute repeat celiotomy through a ventral median or a right ventral paramedian approach.

OBJECTIVE: To compare tensile strength, failure location, and histologic features after acute repeat celiotomy through a ventral median (RVM) or a right ventral paramedian (RVP) celiotomy in horses. STUDY DESIGN: Ex vivo experimental study. ANIMALS: Adult horses (N = 18). METHODS: Twelve adult horses had original ventral median (OVM) celiotomy. Repeat celiotomy was performed 72 hours postoperatively through the original ventral median (RVM, N = 6) or a RVP (N = 6) celiotomy. Celiotomies were scored daily for edema, drainage, and dehiscence. Fourteen days after repeat celiotomy, horses were euthanatized and abdominal wall containing celiotomy(ies) were collected for biomechanical and histological evaluation. The abdominal wall of control horses (N = 6; no celiotomy) was collected for biomechanical testing. Vital sign variables, incisional edema, and histologic scores were compared using a Wilcoxon signed-rank test. Incisional fibrotic depth and tensile strength per unit length (N/cm) was compared using repeated measures ANOVA. RESULTS: RVM and RVP horses had significantly less tensile strength compared to control horses, but no differences were observed between RVM and RVP horses. No differences in healing, inflammation, infection, or necrosis of repeat celiotomies was observed, but RVP horses accumulated more fibrin and hemorrhage within the incision. RVP horses had significantly greater incisional edema scores, but incisional drainage was more frequent in RVM horses. CONCLUSIONS: Acute repeat celiotomy through a RVM incision results in similar incisional healing and tensile strength compared with repeat celiotomy through a RVP incision.

Ex vivo comparison of bursting strength of ventral median and right ventral paramedian celiotomies in horses.

OBJECTIVE: To compare bursting strength and failure mode between ventral median (VM) and right ventral paramedian (RVP) celiotomies closed with 1 section of USP 7 braided polydioxanone (7PD). STUDY DESIGN: Ex vivo experimental. ANIMALS: Equine cadavers (n = 12). METHODS: A 25 cm VM or RVP (positioned 5 cm lateral to the linea alba) celiotomy was created in fresh equine cadavers. A 200 L polyurethane bladder was inserted into the abdomen. Celiotomies were closed in a simple continuous pattern with 1 section of 7PD. The bladder was inflated with compressed air until construct failure. Horse signalment, body weight, celiotomy type, failure mode (suture or abdominal wall), failure location (adjacent or remote from the celiotomy), and bursting strength (mmHg) were recorded. Interactions between independent and dependent variables were assessed with statistical tests including linear regression. RESULTS: Increasing age (P = .002) and Quarter horse-type breed (P = .01) had a negative effect on bursting strength. When age and breed were controlled, RVP celiotomies had a lower bursting strength compared with VM celiotomies (P = .039). None of the celiotomies failed at the suture. CONCLUSION: VM celiotomies have a greater bursting strength than RVP celiotomies when age and breed are controlled. Celiotomy bursting strength decreases with increasing age and is lower in Quarter horse-type breeds compared with non-Quarter horse-type breeds.