Comparison of median sternotomy closure-related complication rates using orthopedic wire or suture in dogs: A multi-institutional observational treatment effect analysis.

OBJECTIVE: To determine and compare median sternotomy (MS) closure-related complication rates using orthopedic wire or suture in dogs. STUDY DESIGN: Multi-institutional, retrospective observational study with treatment effect analysis. ANIMALS: 331 client-owned dogs, of which 68 were excluded. METHODS: Medical records of dogs with MS were examined across nine referral centers (2004-2020). Signalment, weight, clinical presentation, surgical details, complications, and outcomes were recorded. Follow-up was performed using patient records and email/telephone contact. Descriptive statistics, treatment effect analysis and logistic regression were performed. RESULTS: Median sternotomy closure was performed with wire in 115 dogs and suture in 148. Thirty-seven dogs experienced closure-related complications (14.1%), 20 in the wire group and 17 in the suture group. Twenty-three were listed as mild, four as moderate and 10 as severe. Treatment effect analysis showed a mean of 2.3% reduction in closure-related complications associated with using suture versus wire (95% CI: -9.1% to +4.5%). In multivariable logistic regression, the only factor associated with increased risk of closure-related complications was dog size (p = .01). This effect was not modified by the type of closure used (interaction term: OR = 0.99 [95% CI: 0.96/1.01]). CONCLUSION: The incidence of closure-related complication after MS was low compared to previous reports. The likelihood of developing a closure-related complication was equivalent between sutures and wires, independent of dog size, despite a higher proportion of complications seen in larger dogs (≥20 kg). CLINICAL SIGNIFICANCE: Use of either orthopedic wire or suture appear to be an appropriate closure method for sternotomy in dogs of any size.

Implications of comparative ventral body wall histology on selection of abdominal surgical approach and closure in 12 species of fish.

A ventral midline surgical approach for fish celiotomy is commonly performed in veterinary clinical medicine and research, although the relevant ventral body wall anatomy of many fish species is not well documented. Histological evaluation of tissue samples from the ventral body wall of 12 fish species was performed to provide a reference for surgical approach and closure decisions. The width between muscle bundles running parallel to the long axis and total thickness of tissue layers varied among species. An appreciable space between longitudinal muscles of the ventral body wall and a lack of muscle, vessels and nerves on midline in all species examined supports recommendations of ventral midline incisions to spare important structures. Dense connective tissue consistent with an aponeurosis between musculature along the ventral body wall was not observed in any species evaluated. Connective tissue was concentrated within the dermis of all species evaluated, with an additional layer of collagen along the coelomic membrane in Russian sturgeon Acipenser gueldenstaedtii, koi Cyprinus carpio, goldfish Carassius auratus, black drum Pogonias cromis, black seabass Centropristis striata, tomtate Haemulon aurolineatum and scup Stenotomus caprinus. A sufficiently wide space on ventral midline for practical targeting during the surgical approach is present in A. gueldenstaedtii, C. carpio, striped bass Morone saxatilis, H. aurolineatum, P. cromis, rainbow trout Oncorhynchus mykiss and brown trout Salmo trutta. Sand perch Diplectrum formosum, C. auratus, S. caprinus, grey triggerfish Balistes capriscus and black sea bass Centropristis striata have a negligible space between longitudinal muscles on midline. The variation in ventral body wall structure observed in this study helps inform surgical decision making for celiotomy incision and closure in these species.

Influence of closure technique on leakage pressures in an ex vivo canine typhlectomy model.

OBJECTIVE: To determine the influence of three closure techniques on leakage pressures of canine typhlectomies. STUDY DESIGN: Experimental, ex vivo. SAMPLE POPULATION: Grossly normal cecal segments from 24 adult canine cadavers. METHODS: Typhlectomies were assigned to one of three closure techniques: simple continuous closure with a Parker-Kerr pattern with 4-0 polydioxanone (group 1), closure with a 60-mm gastrointestinal stapler loaded with a 3.8-mm staple cartridge (group 2), and placement of a Cushing suture to augment the stapled closure (group 3). The median (range) of initial leakage pressure (ILP) and maximum leakage pressure (MLP) was compared between groups along with leakage location. RESULTS: Typhlectomies in group 3 leaked at higher ILP (310 mm Hg; 188-310) than those in groups 1 (43 mm Hg; 31-80) and 2 (109.5 mm Hg; 68-173; P < .0001). Maximum leakage pressure were greater in group 3 than in other groups (P < .0001). Leakage was detected in 20 of 24 (83%) typhlectomies, located at the incisional line in 13 of 24 (54%) specimens and from suture holes in seven of 24 (29%) specimens. CONCLUSION: Placement of a Cushing suture pattern to augment stapled incisions improved the ability of typhlectomies to sustain pressure compared with sutured or stapled cadaveric specimens alone. CLINICAL SIGNIFICANCE: These results provide evidence to support placement of a Cushing suture pattern to augment the staple line for typhlectomies in dogs, although in vivo studies are required to determine the clinical significance of these findings.

Ex vivo comparison of barbed sutures for pelvic flexure enterotomy in horses.

OBJECTIVE: To evaluate two different barbed sutures for closure of pelvic flexure enterotomies and compare results achieved with two previously described closure techniques. STUDY DESIGN: Ex vivo. SAMPLE POPULATION: Twenty-four fresh cadaver adult equine large colons. METHODS: Cadavers were randomly assigned to four closure groups (n = 6 each group): single-layer absorbable suture, double-layer absorbable suture, single-layer unidirectional barbed suture, or single-layer bidirectional barbed suture. Construction time, luminal reduction (percentage), bursting pressure, and method of failure were measured. Cost, leakage, exposed suture, and general appearance were recorded. Comparisons were performed with one-way analysis of variance and post hoc Bonferroni test (P < .05). RESULTS: Double-layer absorbable closure had the highest bursting pressure (mean = 178.5 mm Hg, SD = 9.79, P < .001) but took more time (P = .001) compared with all other groups. The construction time of both barbed suture closures did not differ from the single-layer closure (P > .06). Bursting strengths of both unidirectional (mean = 91.6 mm Hg, SD = 5.57) and bidirectional (mean = 87.5 mm Hg, SD = 8.69) barbed sutures were lower (P > .006 for both) than those of both single- (mean = 117.6 mm Hg, SD = 11.69) and double-layer (mean = 178.5 mm Hg, SD = 9.79) closures. Unidirectional barbed suture closure had a reduction in lumen diameter (P = .004) compared with bidirectional and single-layer closures. CONCLUSION: Enterotomy closures with the two different barbed suture patterns were comparable in bursting strength and construction time. However, the barbed suture patterns had lower bursting strength compared with traditional single- and double-layer closures. Unidirectional barbed suture closure also reduced lumen diameter. CLINICAL SIGNIFICANCE: Closure of a large colon enterotomy with barbed suture patterns may be less secure than single- and double-layer suture closure.

Effect of subcutaneous closure technique on incisional complications and postoperative pain in cats undergoing midline celiotomy: A randomized, blinded, controlled trial.

OBJECTIVE: To compare the effect of three methods of subcutaneous tissue closure on postoperative incisional complications and pain in cats. STUDY DESIGN: Single-center, randomized, blinded, controlled trial conducted in a veterinary teaching hospital. ANIMALS: Two hundred ninety-seven cats undergoing midline celiotomy for ovariohysterectomy (n = 280) or other abdominal procedure (n = 17). METHODS: Cats (n = 297) were assigned to one of three subcutaneous closure methods: simple continuous apposition with tacking to the rectus fascia (n = 108, quilting [Q] group); simple continuous apposition (SC; n = 94); no subcutaneous closure (NC; n = 95). Primary outcomes were incidence of seroma formation, postoperative pain, and surgical site infection or dehiscence. Active follow-up was obtained at 10 and 30 days postoperatively. RESULTS: Baseline characteristics did not differ between groups. Seroma was less common in the Q group (13.0%) than in the NC (27.3%) and SC (25.9%) groups (P = .03). Compared with the other two groups, the relative risk of seroma formation in the Q group was 0.49 (95% CI = 0.28-0.86, P = .01). Median mechanical pain thresholds were higher (indicating greater comfort) in cats with subcutaneous sutures (Q and SC = 1.23 [interquartile range (IQR), 0.2-2.6 N], NC = 0.83 [IQR, 0-1.87 N], P = .04) on the day after surgery. CONCLUSION: Closing subcutaneous tissues with a quilting closure pattern reduced seroma formation in cats undergoing celiotomy. CLINICAL SIGNIFICANCE: Placing a quilting suture pattern in the subcutaneous tissues after celiotomy is a simple low-cost measure that reduces seromas in cats. Abstaining from subcutaneous closure cannot be recommended because of increased seroma formation and pain.

Management and closure of multiple large cutaneous lesions in a juvenile cat with severe acquired skin fragility syndrome secondary to iatrogenic hyperadrenocorticism.

CASE DESCRIPTION A 13-month-old castrated male cat was evaluated for a large, spontaneously developed cutaneous laceration over the left scapular region. The cat had a history of severe gingivostomatitis, conjunctivitis, giardiasis, and feline herpesvirus infection and had received systemic glucocorticoid treatment for 7 weeks prior to evaluation. CLINICAL FINDINGS Physical examination revealed a 10 × 7-cm full-thickness cutaneous laceration over the left scapular region, extremely thin skin, crusts over the dorsal aspect of the neck and base of the skull, medially curling pinnae, and moderate gingivostomatitis. TREATMENT AND OUTCOME Staged wound closure was performed with a combination of daily wound cleaning and debridement, tension and appositional sutures, and wet-to-dry and nonadherent dressings initially with a bacitracin, neomycin, and polymyxin B ointment and then with a 30:1 mixture of silver sulfadiazine and insulin. Multiple additional lesions developed and were treated in the same manner. Complete closure and resolution of all cutaneous lesions was achieved in 9 weeks. CLINICAL RELEVANCE Cats are fairly resistant to the adverse effects of glucocorticoid treatment, and iatrogenic hyperadrenocorticism is rarely reported. This case demonstrated that acquired skin fragility syndrome secondary to iatrogenic hyperadrenocorticism can develop following short-term systemic glucocorticoid administration and that large cutaneous wounds associated with this condition can be successfully managed and closed by means of the reported methods. The prognosis for skin recovery in cats with acquired skin fragility syndrome may be more favorable than previously reported.

Biomechanical properties of feline ventral abdominal wall and celiotomy closure techniques.

OBJECTIVE: To compare biomechanical properties and mechanism of failure of 3 regions of ventral abdominal wall in cats by using 2 suture materials, 2 suture bite-to-stitch intervals (SBSI), and full-thickness versus fascia-only closure. STUDY DESIGN: Randomized, cadaveric, ex vivo mechanical testing. SAMPLE POPULATION: 16 adult cat cadavers, 3 samples per cat. METHODS: Three regions of ventral abdominal wall were mechanically tested (N = 48 samples). Preumbilical, umbilical (U), and postumbilical (POU) regions were harvested by using a template. The thickness of the linea alba was recorded. Six samples without celiotomy served as controls. Twenty-eight samples were randomized to SBSI (2 × 2 or 5 × 5 mm) and suture material (3-0 polyglactin 910 or 3-0 polydioxanone) for simple continuous celiotomy closure. Fourteen samples were randomized to full-thickness or fascia-only closure. Samples were tested by linear distraction; tensile strength and mechanism of failure were recorded. Effects of body weight, thickness of linea alba, anatomic region, SBSI, type of closure, and suture material were evaluated by mixed model linear analysis. Load to failure was compared between males and females, full-thickness and fascia-only closure by independent t test, with P < .05 considered statistically significant. RESULTS: The POU region achieved lower loads to failure. Load to failure was greater in males compared with females. No difference was detected between full-thickness and fascia-only closure. Failure most commonly occurred by tearing of suture through tissues. Tissue failure with suture line loosening occurred mainly in the 5 × 5-mm SBSI group. CONCLUSION: The POU region is biomechanically weak and may therefore be predisposed to incisional herniation.

Comparison of surgical time and complication rate of subcutaneous and skin closure using barbed suture or traditional knotted suture in dogs.

This prospective study evaluated the handling, intraoperative and postoperative complication rates of a barbed knotless suture for closure of subcutaneous tissue and skin in 17 client-owned dogs (group A) following a tibial plateau leveling osteotomy procedure. Clinical characteristics, surgical time, and complication rates were compared to a control group of 17 client-owned dogs (group B) with subcutaneous tissue and skin closure using traditional suture material. Signalment was not significantly different between groups and did not have an effect on complication rates. Surgical times were not significantly different for subcutaneous tissue or skin closure between the 2 groups. There were significantly more intraoperative complications in the barbed suture group (A: 4/17; B: 0/17; P = 0.033) but no difference in minor or major postoperative complication rates (minor A: 2/16; B: 1/14; P = 0.626, major A: 2/16; B: 0/14; P = 0.171).

Comparaison du temps opératoire et du taux de complication de la fermeture sous-cutanée et de la peau en utilisant des points de suture barbelés ou des points de suture noués traditionnels chez les chiens. Cette étude prospective a évalué les taux de complication liés à la manipulation, peropératoire et postopératoire des points de suture barbelés sans noeuds pour la fermeture du tissu sous-cutané et de la peau chez 17 chiens appartenant à des clients (groupe A) après une intervention d'ostéotomie de nivellement du plateau tibial. Les caractéristiques cliniques, le temps opératoire et les taux de complication ont été comparés à un groupe témoin de 17 chiens appartenant à des clients (groupe B) avec du matériel de suture traditionnel pour la fermeture du tissus sous-cutanés et de la peau. Le signalement n'était pas significativement différent entre les groupes et n'a pas eu d'effet sur les taux de complication. Le temps opératoire n'était pas significativement différent pour la fermeture du tissu sous-cutané ou de la peau entre les deux groupes. Il y avait significativement plus de complications peropératoires dans le groupe à points de suture barbelés (A : 4/17; B : 0/17; P = 0,033) mais aucune différence pour les taux de complications postopératoires mineures ou majeures (mineure A : 2/16; B : 1/14; P = 0,626, majeure A : 2/16; B : 0/14; P = 0,171).(Traduit par Isabelle Vallières).

Ex vivo comparison of single-layer and double-layer laparoscopic closure of equine bladders with 2 types of barbed sutures.

OBJECTIVE: To compare laparoscopic single-layer versus double-layer closure of experimental, full-thickness incisions in adult equine urinary bladders using unidirectional and bidirectional barbed suture. STUDY DESIGN: Experimental, ex vivo, surgical study. SAMPLE POPULATION: Thirty adult equine cadaver urinary bladders. METHODS: Bladders were randomly divided into 5 groups (n = 6): intact controls, bladders sutured with unidirectional or bidirectional barbed suture in a single-layer closure, and bladders sutured with unidirectional or bidirectional barbed suture in a double-layer closure. A 5-cm apical incision was created in each bladder assigned to a suture group, prior to closure in a laparoscopic trainer. After suturing, bursting pressures (BPs) were determined by filling the bladders with saline to failure. Continuous variables were compared among groups using generalized linear modeling with post hoc testing between groups, and categorical variables were compared using Fisher's exact test. Significance was set at P < .05. RESULTS: No difference in BP was detected between treatment groups, all failing at pressures lower than those of intact bladders. The 95% confidence interval for BPs exceeded a physiologically relevant threshold of 30 mm Hg after single-layer or double-layer closure. Irrespective of treatment group, surgical time decreased with experience, and the rate of reduction was greater for the single-layer than the double-layer closures. CONCLUSION: In this ex vivo study, both closure techniques and both suture types appeared to be acceptable for laparoscopic closure of the urinary bladder in adult horses.

Treatment of a perforating thoracic bite wound in a dog with negative pressure wound therapy.

CASE DESCRIPTION A 4-year-old male Dachshund was examined following a bite attack that had occurred 5 days previously. The dog had acutely deteriorated despite IV antimicrobial treatment and fluid therapy. CLINICAL FINDINGS On initial examination, the patient was recumbent with signs of septic shock and a flail chest. Three penetrating wounds in the left thoracic wall with malodorous discharge were evident. The animal trauma triage score was 8 out of 18. Thoracic and abdominal radiography revealed displaced fractures of the left seventh, eighth, and ninth ribs and extensive subcutaneous emphysema. Additionally, a marked diffuse bronchointerstitial pattern, areas of alveolar pattern, and pneumothorax were present bilaterally. TREATMENT AND OUTCOME Open surgical debridement with left lateral lung lobectomy and resection of portions of the left thoracic wall were performed. Extensive soft tissue loss precluded primary reconstruction. The defect was stabilized with a polypropylene mesh implant, and negative pressure wound therapy (NPWT) at -100 mm Hg was initiated. Microbial culture and susceptibility testing of tissue samples indicated the presence of multidrug-resistant Staphylococcus pseudintermedius. The NPWT dressing was changed 2, 5, and 7 days after surgery. Treatment was well tolerated, and the mesh was completely covered with granulation tissue 10 days after surgery. On follow-up 5, 7, 12, and 19 months after surgery, the dog was clinically normal with no apparent complications. CLINICAL RELEVANCE Findings suggested that NPWT may be a valuable adjunct when treating small animal patients with severe thoracic trauma.

Effects of an optional clinical skills laboratory on surgical performance of third-year veterinary students.

OBJECTIVE: To determine whether addition of an optional clinical skills laboratory (OCSL) to the traditional surgery curriculum would affect total surgery time or incision closure time in veterinary students performing ovariohysterectomy of a dog during a third-year surgery course. DESIGN: Retrospective and prospective study of veterinary student attendance at OCSL sessions and student performance during the third-year surgery course. SAMPLE: Students from the classes of 2012, 2013, and 2014 at the Washington State University College of Veterinary Medicine. PROCEDURES: For all students, total surgery time and incision closure time were recorded when students performed an ovariohysterectomy of a dog during their third-year live-animal surgery course. Times were analyzed to identify differences among classes and determine whether times were associated with number of OCSL sessions attended, previous experience performing ovariohysterectomies, or enrollment in an elective clinical skills course. RESULTS: Total surgery and incision closure times were not significantly different between students in the class of 2012 (no access to the OCSL prior to the third-year surgery course) and students in the class of 2013 (ie, access to 4 OCSL sessions during the spring semester prior to the third-year surgery course). However, times were significantly shorter for students in the class of 2014 (ie, students who had access to OCSL sessions during the 3 semesters prior to the third-year surgery course) than for students in the other 2 classes. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that attendance in the OCSL sessions was associated with improvements in surgical performance, as reflected in faster total surgery and incision closure times while performing an ovariohysterectomy during the third-year surgery course.

Principles of Wound Management and Wound Healing in Exotic Pets.

The care of wounds in exotic animal species can be a challenging endeavor. Special considerations must be made in regard to the animal's temperament and behavior, unique anatomy and small size, and tendency toward secondary stress-related health problems. It is important to assess the entire patient with adequate systemic evaluation and consideration of proper nutrition and husbandry, which could ultimately affect wound healing. This article summarizes the general phases of wound healing, factors that affect healing, and principles of wound management. Emphasis is placed on novel methods of treating wounds and species differences in wound management and healing.

Current concepts in wound management and wound healing products.

Current concepts in wound management are summarized. The emphasis is on selection of the contact layer of the bandage to promote a moist wound environment. Selection of an appropriate contact layer is based on the stage of wound healing and the amount of wound exudate. The contact layer can be used to promote autolytic debridement and enhance wound healing.

Comparison of three skin-stretching devices for closing skin defects on the limbs of dogs.

Our objective was to evaluate the effectiveness of skin-stretching devices for closing defects on the extremities of dogs. Antebrachial skin defects were created on the limbs of 24 dogs randomly divided into three groups. Skin stretchers included staples and sutures passing through them (group A), sutures and hypodermic needles (group B), and Pavletic device (group C). Wounds on the left were further undermined in all groups. Tension and blood perfusion were assessed. After removing the stretchers on day 3, the defects were sutured and wound healing was clinically scored. Histological variables evaluated were cellular infiltration, edema, collagen orientation, and thickness of epidermis. Significant differences in tension were found among groups (p 0.0005) and between measurement times for undermined (p = 0.001) or non-undermined (p < 0.0005) wounds. In contrast, blood perfusion values did not differ significantly. Clinical scores for group B seemed to be better than those for groups A and C, but differences were not significant. Primary wound closure using the Pavletic device was not feasible. No significant differences in histological variables were found between groups. Skin stretching with staples or hypodermic needles resulted in successful wound management with minor side effects on skin histology and circulation.

Use of a vessel sealant device for cystic duct ligation in the dog.

OBJECTIVE: To compare a vessel sealant device to hemostatic clips for cystic duct ligation in a canine cadaveric model. STUDY DESIGN: Experimental. METHODS: Hepatobiliary systems were collected from normal dogs. A microtip pressure transducer was inserted into the common bile duct and a 20-24 g intravenous catheter was placed in a hepatic duct. The cystic duct was ligated with 1 of 3 techniques: vessel sealant device (VSD), 10 mm medium Endoclips™, or 10 mm large Endoclips™ with 6 specimens in each group. Methylene blue was infused until failure, which was recorded as seal/clip failure or retrograde movement of methylene blue into the liver. RESULTS: Mean failure pressure of the medium endoclip group was significantly lower than the large endoclip group (P = .014). There was no difference between the failure pressure of the VSD group and the medium and large endoclip groups (P = .097, P = .34, respectively). Failure by leakage at the cut surface of the cystic duct occurred in 2 specimens in the medium endoclip group while all others failed by retrograde flow of the methylene blue through the hepatic ducts. CONCLUSIONS: The vessel sealant device appears comparable to large endoclips for closure of the cystic duct in an acute cadaveric model, while medium endoclips may not fully compress or span the diameter of a cystic duct in large breed dogs and leak at lower pressures.

Effect of enteric biopsy closure orientation on enteric circumference and volume of saline needed for leak testing.

This study describes the effect of enteric biopsy closure orientation on circumference and volume of saline needed for leak testing. There were significant differences in circumference measurements at baseline, central circumference of longitudinally closed sites, and volume of saline for leak testing.

Effet de l'orientation de la fermeture de la biopsie entérique sur la circonférence entérique et le volume de solution saline requis pour l'essai d'étanchéité. Cette étude décrit l'effet de l'orientation de la fermeture de la biopsie entérique sur la circonférence et le volume de solution saline requis pour l'essai d'étanchéité. Il y avait des différences importantes dans les mesures de la circonférence pour les données de référence, la circonférence centrale des sites fermés longitudinalement et le volume de solution saline pour l'essai d'étanchéité.(Traduit par Isabelle Vallières).

Successful wound healing over exposed metal implants using vacuum-assisted wound closure in a dog.

An eight-month-old Labrador retriever was presented with a grade IIIb open shearing injury of the left tarsus. Acute severe surgical site infection developed 2 days after pan-tarsal arthrodesis, resulting in wound dehiscence. Vacuum-assisted wound therapy was carried out for 12 days to treat an extensive full-thickness soft tissue defect with exposure of metal implants. New granulation tissue formation covering most of the defect was achieved by day 10 of this therapy. Epithelialization was achieved by second intention healing with open wound management. To the authors' knowledge, this is the first veterinary clinical case report documenting complete healing over exposed metal implants without any requirement for surgical revision.

Ex vivo comparison of 7 polydioxanone, 2 polyglactin 910 for closure of ventral median celiotomy in horses.

OBJECTIVE: To compare bursting strength and failure mode between ventral median celiotomies closed with USP 7 braided polydioxanone (7PD) or USP 2 polyglactin 910 (2PG). STUDY DESIGN: Ex vivo experimental. ANIMALS: Equine cadavers (n = 10). METHODS: A 25 cm ventral median 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 2 sections of 7PD or 2PG. The bladder was inflated with compressed air until construct failure. The horses' signalment, body weight, suture type, failure mode (suture or abdominal wall), and bursting strength (mmHg) were recorded. Interactions between independent and dependent variables were assessed with statistical tests including linear regression. RESULTS: Failure mode was significantly different by suture type (P = .01). Four of 5 celiotomies closed with 2PG failed at the suture; whereas, 0 celiotomies closed with 7PD failed at the suture. In celiotomies closed with 7PD, increasing age was highly and negatively correlated with bursting strength (r = -0.99). When the effect of age was controlled, 7PD had a significantly higher bursting strength than 2PG (P = .024). CONCLUSION: 7PD has a higher bursting strength compared with 2PG. Suture failure was the main failure mode for 2PG; whereas, all celiotomies closed with 7PD failed at the abdominal wall.