Evaluation of three ligatures in simulated equine open castration.

OBJECTIVE: To compare three surgical knots for preventing leakage from the vascular bundle during ligation in simulated equine open castrations. STUDY DESIGN: Randomized, case-control, in vitro study. SAMPLE POPULATION: Testes (N = 60) collected from 30 horses. METHODS: Testes were collected from 30 horses and randomly assigned to one of three groups: group G (friction, giant knot), group T (modified transfixing knot), or group S (sliding, strangle knot; n = 20/group). The assigned knot was used to ligate the vascular bundle during open castration. The length of suture material used and the leak pressure of the testicular artery were measured and compared between groups. RESULTS: Strangle knots consistently leaked at higher pressures (median, 735.5 mm Hg; interquartile range [IQR], 735.5-735.5) compared with giant (median, 441.3 mm Hg; IQR, 367.8-643.6) and transfixing (median, 419.2 mm Hg; IQR, 323.6-643.6; P < .0001) knots. Both the strangle (median, 5 cm; IQR, 4.5-5.5) and giant (median, 6 cm; IQR, 5.35-6.075) knots required less suture material compared with the transfixing (median, 9.2 cm; IQR, 8.425-10.38; P < .0001) knot. CONCLUSION: The three surgical knots tested withstood pressure well above physiological levels in simulated open castrations. The strangle knot withstood higher pressure and required similar (giant) or less (transfixing) suture material than the other two knots. CLINICAL SIGNIFICANCE: This study provides evidence to support the use of a strangle knot to ligate the vascular bundle during simulated open castrations in horses.

A new, easy-to-make pectin-honey hydrogel enhances wound healing in rats.

BACKGROUND: Honey, alone or in combination, has been used for wound healing since ancient times and has reemerged as a topic of interest in the last decade. Pectin has recently been investigated for its use in various biomedical applications such as drug delivery, skin protection, and scaffolding for cells. The aim of the present study was to develop and evaluate a pectin-honey hydrogel (PHH) as a wound healing membrane and to compare this dressing to liquid honey. METHODS: Thirty-six adult male Sprague-Dawley rats were anesthetized and a 2 × 2 cm excisional wound was created on the dorsum. Animals were randomly assigned to four groups (PHH, LH, Pec, and C): in the PHH group, the pectin-honey hydrogel was applied under a bandage on the wound; in the LH group, liquid Manuka honey was applied; in the Pec group, pectin hydrogel was applied (Pec); and in the C group, only bandage was applied to the wound. Images of the wound were taken at defined time points, and the wound area reduction rate was calculated and compared between groups. RESULTS: The wound area reduction rate was faster in the PHH, LH, and Pec groups compared to the control group and was significantly faster in the PHH group. Surprisingly, the Pec group exhibited faster wound healing than the LH group, but this effect was not statistically significant. CONCLUSION: This is the first study using pectin in combination with honey to produce biomedical hydrogels for wound treatment. The results indicate that the use of PHH is effective for promoting and accelerating wound healing.

Ex Vivo Evaluation of Skin Staples for Typhlotomy Closure in Cattle.

OBJECTIVE: To compare 2 sutured techniques with a skin stapled technique for typhlotomy closure in bovines. STUDY DESIGN: Ex-vivo study. SAMPLE POPULATION: Bovine fresh cadaveric ceca (n = 27). METHODS: Typhlotomies (4 cm in length) were made on the cecal apex and closed with 1 of the following techniques: hand-sewn, 2-layer suture consisting of a continuous, full-thickness layer oversewn with a Cushing layer (Group FC); hand-sewn, double inverting suture consisting of a 1st Cushing layer oversewn with an additional Cushing layer (Group CC); skin staples (Group S). Closure time, bursting pressure, and related costs of each technique were calculated and compared. RESULTS: Median (range) construction time for group S was 1.12 (0.49-1.3) min and was significantly shorter than for group FC 5.14 min (3.45-7.44), and for group CC 4.26 min (2.3-5.52) (95% CI 3.342-4.851), (P = .007). There was no significant difference between bursting pressures of group S (91.67 ± 15.41 mmHg, 95% CI 79.82-103.5) compared with group FC (119.4 ± 40.03 mmHg, 95% CI 88.67-150.2) (P = .160) and compared with group CC (103.3 ± 32.31 mmHg, 95% CI 78.5-128.2) (P = .707) CONCLUSION: Hand-sewn techniques are effective but fairly demanding in terms of time. Skin staples are less time-consuming, and resist pressures comparable to those resisted by handsewn techniques. For this reason, an SKS technique may be a valid option for typhlotomy closure in cattle.

The Surgeon's View: Comparison of Two Digital Video Recording Systems in Veterinary Surgery.

Video recording and photography during surgical procedures are useful in veterinary medicine for several reasons, including legal, educational, and archival purposes. Many systems are available, such as hand cameras, light-mounted cameras, and head cameras. We chose a reasonably priced head camera that is among the smallest video cameras available. To best describe its possible uses and advantages, we recorded video and images of eight different surgical cases and procedures, both in hospital and field settings. All procedures were recorded both with a head-mounted camera and a commercial hand-held photo camera. Then sixteen volunteers (eight senior clinicians and eight final-year students) completed an evaluation questionnaire. Both cameras produced high-quality photographs and videos, but observers rated the head camera significantly better regarding point of view and their understanding of the surgical operation. The head camera was considered significantly more useful in teaching surgical procedures. Interestingly, senior clinicians tended to assign generally lower scores compared to students. The head camera we tested is an effective, easy-to-use tool for recording surgeries and various veterinary procedures in all situations, with no need for assistance from a dedicated operator. It can be a valuable aid for veterinarians working in all fields of the profession and a useful tool for veterinary surgical education.

Ex vivo comparison of barbed and unbarbed sutures for the closure of caecal and pelvic flexure enterotomies in horses.

In this study the caecum and large colon were harvested from 24 slaughtered horses. On each sample, an 8­cm long enterotomy was performed. Enterotomies were closed using either barbed or unbarbed glycomer­631. We compared the time to close, appearance, length of suture material, bursting pressure, and costs associated with each type of material. Our findings demonstrated that time to close was significantly shorter (caecum, P = 0.034; pelvic flexure, P = 0.039) using barbed sutures (caecum 610.4 seconds; pelvic flexure 699.3 seconds) than unbarbed sutures (caecum 661.0 seconds, pelvic flexure 743.1 seconds). The length of suture material used was significantly less (caecum, P < 0.0001; pelvic flexure, P < 0.0001) with barbed (caecum 28.1 cm, pelvic flexure 32.0 cm,) compared with unbarbed sutures (caecum 41.6 cm; pelvic flexure 46.6 cm). There were no significant differences in bursting pressure (caecum, P = 0.294; pelvic flexure, P = 0.430) between barbed (caecum, 172.5 mmHg, pelvic flexure, 188.9 mmHg) and unbarbed sutures (caecum 178.3 mmHg, pelvic flexure 183.3 mmHg). The cost was higher using barbed sutures. However, the use of barbed sutures was faster, left less suture material in the tissue, and sustained comparable bursting pressure to unbarbed sutures. We therefore conclude that barbed sutures are a valid alternative to unbarbed sutures for closing large intestine enterotomy in horses.

Evaluation of various hemostatic knot configurations performed by veterinary students.

OBJECTIVE To determine the most effective hemostatic knot configuration performed by veterinary students following a brief training session with an experienced surgeon and a subsequent deliberate self-training period. DESIGN Experiment. SAMPLE 24 fourth-year veterinary students with no previous surgical knot-tying experience. PROCEDURES In a 1-hour training session, an experienced surgeon showed veterinary students how to perform 5 hemostatic knot configurations (giant, slip, strangle, surgeon's, and transfixing), which they then practiced at home on a hemostasis simulator for 2 weeks. Thereafter, students performed each knot 4 times (twice each with monofilament and multifilament suture) on a hemostasis simulator. An experienced surgeon evaluated the correct execution of knots and measured their effectiveness by use of a manometer to measure vessel pressure distal to the ligature. Each student completed a questionnaire regarding their perceived learning and execution difficulty and sealing security for each knot. Responses were compared among knots and suture materials. RESULTS Overall, students considered the surgeon's knot the easiest to learn and the strangle knot the most difficult. The slipknot was also considered the easiest knot to perform, and the giant knot was considered the most difficult. The strangle knot was deemed the most effective in reducing vessel pressure distal to the ligature. CONCLUSIONS AND CLINICAL RELEVANCE The strangle knot was the most effective hemostatic knot in inexperienced hands, although veterinary students considered it more difficult to learn than other, perhaps more commonly taught, knots. Therefore, teaching of the strangle knot should be encouraged in veterinary schools.

Cleaning with a wet sterile gauze significantly reduces contamination of sutures, instruments, and surgical gloves in an ex-vivo pelvic flexure enterotomy model in horses.

The objective of this study was to investigate whether cleaning surgical materials used to close pelvic flexure enterotomies with a wet sterile gauze will reduce contamination and whether the use of a full thickness appositional suture pattern (F) or a partial thickness inverting (or Cushing) suture pattern (C) would make a difference in the level of contamination. Large colon specimens were assigned to group F or C and divided into subgroups N and G. In group G, a wet sterile gauze was passed over the suture material, another over the instruments, and another over the gloves. In group N, no treatment was applied. The bacterial concentration was measured by optical density (OD) at 24 h. The OD of subgroup CG was lower than that of subgroup CN (P = 0.019). The OD of subgroup FG was lower than that of subgroup FN (P = 0.02). The OD of subgroups CG, CN, FG, and FN was lower than that of the negative control (P < 0.003, P < 0.001, P < 0.001, and P < 0.00). The use of a sterile wet gauze significantly reduced contamination of suture materials. A partial thickness inverting suture pattern did not produce less contamination than a full thickness appositional suture pattern.

L'objectif de la présente étude était d'examiner si le nettoyage du matériel chirurgical utilisé pour fermer les entérotomies de la courbure pelvienne avec une gaze stérile mouillée réduisait la contamination et si l'utilisation d'un patron de suture d'apposition de la pleine épaisseur (F) ou d'un patron de suture inversé d'une épaisseur partielle (ou Cushing) (C) faisait une différence dans le degré de contamination. Des spécimens du gros côlon ont été assignés au groupe F ou C dans les sous-groupes N et G. Dans le groupe G, une gaze stérile mouillée a été passée par-dessus le matériel de suture, une autre par-dessus les instruments, et une autre par-dessus les gants. Dans le groupe N, aucun traitement ne fut effectué. Les concentrations bactériennes ont été mesurées par densité optique (DO) à 24 h. La DO du sous-groupe CG était inférieure à celle du sous-groupe CN (P = 0,019). La DO du sous-groupe FG était inférieure à celle du sous-groupe FN (P = 0,02). Les DO des sous-groupes CG, CN, FG, et FN étaient inférieures à celles des témoins négatifs (P < 0,003, P < 0,001, P < 0,001, et P < 0,00). L'utilisation d'une gaze stérile mouillée a réduit de manière significative la contamination de matériel de suture. Un patron de suture inversé avec épaisseur partielle n'a pas entrainé moins de contamination qu'un patron de suture par apposition avec pleine épaisseur.(Traduit par Docteur Serge Messier).

Laparoscopic nephrosplenic space ablation with barbed suture in eight horses.

CASE DESCRIPTION 8 horses (5 geldings and 3 mares) were evaluated for laparoscopic closure of the nephrosplenic space following a history of recurrent left dorsal displacement of the large colon. CLINICAL FINDINGS All horses underwent a physical examination and routine clinicopathologic testing. Transrectal palpation and transabdominal ultrasonography were performed to exclude the presence of organs in the left paralumbar region. TREATMENT AND OUTCOME A left flank laparoscopic approach with the horses standing was used. A continuous suture was placed in a craniocaudal direction between the renal and splenic capsules with unidirectional barbed suture material. This allowed obliteration of the nephrosplenic space without the need for knots to secure the leading and terminal ends of the suture line. In all horses, transrectal palpation was performed 2 months after surgery; at this time, closure of the caudal part of the nephrosplenic space was evident. In 2 horses, follow-up laparoscopy was performed, and complete closure of the nephrosplenic space was confirmed. Telephone follow-up revealed that none of the horses had any signs of recurrent left dorsal displacement of the large colon. CLINICAL RELEVANCE Results suggested that laparoscopic nephrosplenic space closure with unidirectional barbed suture material could be considered as an option for prevention of left dorsal displacement of the large colon in horses. In the horses of this report, barbed suture material allowed secure ablation of the nephrosplenic space and eliminated the need for intracorporeal knot tying.