Evaluation of an Autotutorial-Simulator Program for Instruction of Hollow Organ Closure

Forty students were randomly assigned into two study groups (traditional, T; and simulator, S) of 20 students each for a core operative practice laboratory. Students were randomly paired and their group assignment and identity remained anonymous to the evaluators throughout the study. Questionnaires were distributed to students to evaluate prior surgical experience and obtain learning resource use information. Before the evaluation sessions, both groups were given identical learning resource opportunities except students in Group S received hollow organ simulators and practice materials for gastrotomy closure. All students were forewarned that surgical instruction would not be available during the evaluation sessions. In the first live animal evaluation session, all student pairs were videotaped after which stomachs were harvested for gross evaluation of the surgical site. Group T performed an additional gastrotomy for video and gross evaluation 2 weeks later. Questionnaire, and gross and video evaluation results were compared statistically between groups and sessions. The hollow organ model did not suitably simulate live stomach tissue; the material was more fragile and stiff and suture cut-out was a problem even with appropriate suture tension and technique. The model was effective for teaching needle placement, instrument usage, creating proper tissue inversion, and methods to minimize instrument handling of tissue during gastrotomy closure. Prior practice with models did not boost student confidence during their live gastrotomy session. The autotutorials (ATs) were well received by students but did not sufficiently address how to manage mucosal eversion, suture tension, and bleeding encountered during live gastrotomy. AT viewing lime positively correlated with mean total video score for Group T during both sessions. None of the students had prior experience performing hollow organ closure and no significant difference in experience level was evident between groups. Mean closure time was not significantly different between groups for session one (Group T, mean, 31.5 minutes, range, 18.4 to 53.4; Group S, mean, 28.2 minutes, range, 16.8 to 36), but was significantly reduced for session two (Group T, mean, 21.3 minutes, range, 13.9 to 31). This AT/simulator program does not significantly influence students' overall gastrotomy closure technique; gross and video evaluation scores were not significantly different between groups. Without instructor supervision, an additional gastrotomy experience did not improve surgical technique appreciably for Group T; however, these students performed the second procedure with more confidence and speed. Instruction during simulator or live animal practice appears to be necessary to assure adequate skill mastery and to reduce perpetuation of mistakes.     

The Mesh Expansion Method of Suturing Wounds on the Legs of Horses

Wound closure utilizing tension-relieving incisions located in the skin adjacent to the wound of horses was evaluated in three experiments. Healing of lower limb wounds was compared in four treatment groups; wounds sutured under tension, wounds sutured with 7 mm and 10 mm tension relieving incisions, and unsutured controls. The wounds sutured using 10 mm tension relieving incisions healed significantly faster than the other three groups (p > 0.05). The mesh expansion technique was further evaluated in four-week-old granulating wounds. The technique was found to be unsuccessful because the tension relieving incisions that were used were too small and postoperative support was inadequate. The technique was evaluated in two clinical patients, both of which had large metatarsal lacerations. Tension relieving incisions of approximately 15 mm were made and full leg walking bar casts were applied. Both wounds had healed almost completely on removal of the casts four weeks postoperatively.     

Pyloric obstruction in a dog related to a gastrotomy incision closed with polypropylene

A five-year-old male, West Highland terrier was treated for a gastrointestinal foreign body via a gastrotomy incision and enterotomies. The dog was asymptomatic for several months but was eventually re-presented because of vomiting. Endoscopic and surgical evaluation confirmed a large mass within the pyloric canal that probably resulted from a reaction to the polypropylene suture material used to close the original gastrotomy incision. The mass was excised via a Y-U pyloroplasty incision and the dog has been free of vomiting for over a year.     

Laparoscopic removal of gastric foreign bodies in dogs--comparison of manual suturing and stapling viscerosynthesis

This study was an attempt to evaluate the application of various laparoscopic techniques of removing foreign bodies from the stomach in dogs in comparison to conventional laparotomy. The research was conducted on two groups of 10 dogs each with clinically confirmed foreign bodies in the stomach. In case of all patients, a laparoscopic instrument, EndoBag, was used for the removal of the foreign body from the stomach and the abdominal cavity. Manual suturing with the use of Szabo-Berci suturing kit was used for the gastrotomy wound closure in group I. In group II, linear staplers were used for viscerosynthesis. All patients were subjected to radiological assessment of tightness of anastomosis. No significant differences between the quality of the performed stomach anastomosis were shown. Therefore, the competitiveness of an economical manual suturing in comparison with the very expensive mechanical suturing preferred in human surgery was confirmed. The described procedures of laparoscopic gastrotomy seem to be applicable for removing foreign bodies from the stomach in a clinical veterinary practice.     

Comparison of absorbable and nonabsorbable sutures for intradermal skin closure in cats

Paired skin incisions were made in 6 cats and closed intradermally with the copolymer of glycolide, ɛ-caprolacton, and trimethylene-carbonate, or polypropylene suture. The macroscopic and histologic appearance of the incisions was compared. Polypropylene suture compared favorably to glycolide, ɛ-caprolacton, and trimethylene-carbonate suture for closure of skin incisions in cats.     

Midline scrotal ablation technique for unilateral cryptorchid castration in horses

Thirty-nine unilateral cryptorchid horses were castrated, using a midline scrotal ablation technique. This approach was satisfactory to access both inguinal rings, to eliminate the need for 2 incisions, and to allow for completion of the surgery by primary closure. These horses recovered from surgery with few complications, returned to work promptly, and had excellent cosmetic results.     

Closure of Abdominal Incisions Using A Continuous Polypropylene Suture: Clinical Experience in 550 Dogs and Cats

Closure of midline abdominal wall incisions in 469 dogs and 81 cats following various intraabdominal procedures was accomplished by using a single layer, simple continuous pattern with monofilament polypropylene. Skin was closed using simple interrupted nonabsorbable sutures. Weight of the patients ranged from 1 kg to 80 kg. Length of the incision ranged from 3 cm to 55 cm. There was one dehiscence (0.18%) and no incisional hernias. Results indicate the technique is a dependable, time saving method of abdominal closure.     

Enterotomy Technique in the Descending Colon of the Horse Effect of Location and Suture Pattern

To compare the effects of placing enterotomy incisions on or off the antimesenteric teniae and closing the intestinal mucosa as a separate layer, four longitudinal enterotomies were performed in the descending colon of each of six horses by the following techniques: incision through the antimesenteric teniae with one- and two-layer closure, and incision adjacent to the teniae with one- and two-layer closure. The horses were necropsied at day 33 for evidence of obstruction, adhesions, and ultrasonographic determination of the percent reduction in lumen diameter. Histologic and histomorphometric evaluations included: inflammatory response in the mucosal and seromuscular layers, mucosal atrophy or degeneration, alignment of the incision edges, area of fibrosis, and distance between the incised muscle edges. Adhesions were present in 5 of 24 enterotomies. Incisions adjacent to the teniae resulted in narrower lumen diameters than incisions through the teniae. Inflammatory response was greatest in incisions adjacent to the teniae with two-layer closure. Closure of the mucosa as a separate layer had no effect on any of the parameters evaluated. Enterotomies through the antimesenteric teniae were more easily performed, resulted in less hemorrhage, and maintained a larger lumen diameter than those performed adjacent to the teniae.     

Comparison of incisional bursting strength of simple continuous and inverted cruciate suture patterns in the equine linea alba

OBJECTIVE: To determine the bursting strength of ventral median abdominal incisions closed by either simple continuous or inverted cruciate suture patterns. STUDY DESIGN: Experimental. ANIMAL OR SAMPLE POPULATION: Twelve equine cadavers. METHODS: A 25 cm ventral median incision was made through the linea alba and a 200 L polyurethane bladder was placed within the abdomen. Either a simple continuous or an inverted cruciate pattern using 3 polyglactin 910 with a bite size and suture interval of 1.5 cm was used to close linea incisions. Closure time was recorded for each pattern. The bladder was inflated with air at 40 L/min, and the pressure at body wall failure recorded. The length of suture used for wound closure and the wound failure modes were recorded. Deviation from the linea (cm), total suture length (cm), suture length to wound length ratio (SL:WL), closure time (min), bursting pressure (mm Hg), and failure modes were compared between groups using Welch-Aspin t-tests. The effects of independent subject variables were assessed for possible effects on bursting strength using analysis of covariance. RESULTS: Mean bursting pressure was significantly greater for the simple continuous pattern than for the inverted cruciate pattern (P = .01). Significantly less suture material (P = .0002) was required with the continuous pattern than with the inverted cruciate pattern. Mean closure time, SL:WL, deviation from the linea, and failure modes were not significantly different between groups. No significant effects were noted for independent variables in both groups on bursting strength. CONCLUSIONS: In this model, a simple continuous closure pattern for ventral median abdominal incisions was stronger than an inverted cruciate pattern. A simple continuous pattern leaves less foreign material in the wound, which may be of benefit in reducing incisional complications. CLINICAL RELEVANCE: Use of a continuous closure pattern for the linea alba may offer greater wound security during episodes of increased intra-abdominal pressure in horses.     

Partial orbital rim resection, mesh skin expansion, and second intention healing combined with enucleation or exenteration for extensive periocular tumors in horses

Ocular and periorbital sarcoids and squamous cell carcinoma are common in equine practice. Extensive involvement of periorbital tissues often necessitates removal of the globe if the function of the eyelids can not be maintained with tumor removal alone. This report describes a modification of the standard enucleation or exenteration technique for cases in which there is insufficient skin to achieve primary closure following complete surgical excision. The caudal portion of the dorsal orbital rim is protuberant; partial excision with an osteotome facilitates skin closure by decreasing the size of the wound. Mesh expansion of skin via multiple rows or parallel stab incisions can also be used as an adjunct to facilitate closure. Four horses underwent enucleation or exenteration using the orbital rim resection and mesh skin expansion techniques for extensive periocular tumors that were unresponsive to prior treatments. Follow-up intervals ranged from 6 to 42 months and no horses had tumor regrowth.     

Comparison of gross and histologic tissue responses of skin incisions closed by use of absorbable subcuticular staples, cutaneous metal staples, and polyglactin 910 suture in pigs

OBJECTIVE: To assess gross and histologic tissue responses of skin incisions closed by use of absorbable subcuticular staples, cutaneous metal staples, and polyglactin 910 suture in pigs. ANIMALS: 8 purpose-bred disease-free pigs. PROCEDURE: Pigs were randomly allocated to 1 of 4 groups from which tissues were collected after death on postoperative days (PODs) 7, 14, 21, or 42. In each pig, 4 incisions were made; 1 was closed subcuticularly with 3-0 polyglactin 910 suture, 1 was closed with metal staples, and 2 were closed with absorbable subcuticular staples. Incision sites were grossly evaluated every 3 days after closure. At necropsy, incision sites and surrounding tissues were examined histologically; a histopathologic scoring system was used to quantitate healing and tissue response directed against the closure material. RESULTS: Postoperatively, the metal staples induced a severe inflammatory response, compared with minimal inflammation associated with the suture or absorbable subcuticular staples. Histologic evaluation of incisions on PODs 7, 14, and 21 revealed less severe inflammation associated with absorbable subcuticular staples than that associated with the other materials. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that absorbable subcuticular staples induced a less severe inflammatory response in the early stages of healing in pigs, compared with other commonly used methods of wound closure. Use of absorbable staples potentially combines the benefits of subcuticular closure with the speed and precision of staple placement.     

Comparison of three closure methods and two absorbable suture materials for closure of jejunal enterotomy incisions in healthy dogs

The macroscopic and histological appearance of jejunal antimesenteric incisions approximated with two different absorbable suture materials (monofilament versus multifilament) and three closure techniques (appositional single layer, crushing single layer, and double layer) were compared in healthy dogs at 14 or 28 days, postoperatively. No significant differences between the two suture materials were observed for most of the macroscopic or histological variables. However, the monofilament suture material caused significantly more fibrous tissue reaction in the muscular layer of the jejunum than did the multifilament suture material. Of the three enterotomy closure techniques used in this study, the appositional single-layer method proved to be the best. The double-layer closure method caused a significant decrease in the incisional circumference, the relative circumference, and volume of the jejunum, and a significant increase in jejunal wall thickness. Our findings suggest that canine jejunal enterotomy incisions can be closed using an appositional suture pattern with relatively rapidly absorbable monofilament suture material. The use of double-layer suture patterns for closure of jejunal enterotomy incisions should be avoided because the size of the intestinal lumen may be reduced.     

Cosmetic Dehorning in Goats

Objective — This article describes a technique using primary closure when dehorning goats, and report the results of 22 cases.
Study Design — Medical records of goats that had cosmetic dehorning were reviewed.
Animals or Sample Population — Twenty-two goats.
Methods — The medical records of 22 goats, not previously dehorned by other methods, that were cosmetically dehorned between January 1988 and September 1995 were reviewed. Data retrieved from the medical record included age, breed, sex, surgical technique used for dehorning, and any complications that occurred after surgery. All clients were contacted by telephone to determine the course of postoperative healing for each goat. A surgical technique to remove the horns and close the defect primarily was described.
Results — The mean age of the goats, all male Nubian or Nubian-Spanish cross, was 6.9 months (range, 2 to 24 months). Horn base diameter ranged from approximately 2 to 4 cm. Mean time from surgery until follow-up was 12.9 months (range, 3 to 57 months). All incisions healed by first intention in 10 to 14 days. Clinical signs of sinusitis were not noted, and owners were pleased with the healing time and cosmetic result obtained.
Conclusions — Primary closure of skin defects after dehorning of goats can be achieved with minimal postoperative care and excellent cosmetic appearance.
Clinical Relevance — Primary closure after dehorning in mature goats reduces aftercare.     

Urinary Bladder Incisions in Dogs Comparison of Ventral and Dorsal

The occurrence of postoperative adhesions following ventral (20 dogs) or dorsal (12 dogs) urinary bladder incisions was evaluated. The bladder incisions were sutured with 3–0 polydioxanone suture material in a two-layer closure. Laparotomy (no urinary bladder incision) was performed in four dogs, which served as controls. The surgical sites were examined 1 (30 dogs) and 2 weeks (6 dogs) after surgery. Omental adherence to the urinary bladder was a frequent finding, but none of the urinary bladders was adhered to the ventral abdominal wall incision.     

Continuous absorbable suture pattern in the closure of ventral midline abdominal incisions in horses

A retrospective study was performed to evaluate the healing of ventral midline abdominal incisions, closed with a simple continuous suture pattern using absorbable suture material, in 139 horses and foals. Dehiscence and incisional hernia developed separately in two horses. The low incidence of dehiscence and incisional hernia, compared with their reported incidence following the use of interrupted suture repair, leads the authors to recommend this alternative method of abdominal incision closure in horses. The security of closure is not sacrificed and the advantages of a rapid closure are desirable.     

Surgery: Comparison of three closure methods and two absorbable suture materials for closure of jejunal enterotomy incisions in healthy dogs

Summary

The macroscopic and histological appearance of jejunal antimesenteric incisions approximated with two different absorbable suture materials (monofilament versus multifilament) and three closure techniques (appositional single layer, crushing single layer, and double layer) were compared in healthy dogs at 14 or 28 days, postoperatively. No significant differences between the two suture materials were observed for most of the macroscopic or histological variables. However, the monofilament suture material caused significantly more fibrous tissue reaction in the muscular layer of the jejunum than did the multifilament suture material. Of the three enterotomy closure techniques used in this study, the appositional single‐layer method proved to be the best. The double‐layer closure method caused a significant decrease in the incisional circumference, the relative circumference, and volume of the jejunum, and a significant increase in jejunal wall thickness. Our findings suggest that canine jejunal enterotomy incisions can be closed using an appositional suture pattern with relatively rapidly absorbable monofilament suture material. The use of double‐layer suture patterns for closure of jejunal enterotomy incisions should be avoided because the size of the intestinal lumen may be reduced.     

Esophagotomy Closure in the Dog A Comparison of a Double-Layer Appositional and Two Single-Layer Appositional Techniques

Esophagotomies were performed on 36 dogs and closed with 3-0 polydioxanone in double-layer simple interrupted, single-layer simple interrupted, or single-layer simple continuous patterns. The operative time was shortest for single-layer simple continuous closure, followed by single-layer simple interrupted and double-layer simple interrupted, respectively. Three dogs with each suture pattern were euthanatized at hours 0 and 1, and days 4 and 28 after surgery. The esophagotomy incisions were subjected to bursting strength testing and examined microscopically. The bursting wall tension was higher for all three suture pattern groups at 28 days than at 0 and 1 hour. The double-layer closure had higher bursting wall tension than the single-layer closures at 0 hour and 4 days. Single-layer simple continuous closure had the lowest bursting wall tension for each time period. Single-layer simple interrupted closure had the highest bursting wall tension at 28 days. Microscopic examination revealed close approximation of tissue planes for the double-layer closure and mucosal ever-sion for the simple interrupted and simple continuous single-layer closures. Healing was superior histologically with the double-layer closure.     

Transversus abdominis muscle as a gastric or intestinal on-lay flap in two dogs and one cat

Historically, omentalisation and serosal patching have been used to augment gastrointestinal wall defects or incisions where gastrointestinal viability is of concern. This report describes the novel use of a transversus abdominis muscle on-lay flap to augment and provide support to compromised intestine in three cases. The muscle flap was used to support: the ileum following reduction of an intussusception in a dog (case 1), the gastric wall following gastric strangulation, dilation and volvulus in a diaphragmatic rupture in a cat (case 2) and the jejunum following enterotomy and full-thickness ulcer resection with primary repair in a dog (case 3). All animals were discharged within 4 days postoperatively with no short- or long-term complications reported by either the referring veterinary surgeons on routine postoperative examination or on telephone follow-up with the owners (case 1: 10 months, case 2: 30 months, case 3: 6 weeks). The creation of a flap of the transversus abdominis muscle may provide a useful alternative or adjunct to previously described techniques for supporting the gastrointestinal tract when gastrointestinal tissue viability is questionable or resection is not feasible. Further prospective clinical evaluation studies would be indicated to determine whether the muscle flap remains viable or compare whether this technique should be recommended over conventional methods.     

Surgical implantation of radiotelemetry devices in American river otters

The Oklahoma Department of Wildlife Conservation elected to investigate the feasibility of reintroducing American river otters (Lutra canadensis) into Oklahoma waterways. Intra-abdominal radiotelemetry devices were selected to monitor otter movements following release. For implantation of those devices, the anesthetic regimen included a mixture of ketamine HCl, xylazine, and acepromazine maleate given intramuscularly followed by delivery of isoflurane through precision vaporizers. A ventral midline approach and adherent surgical barrier drapes facilitated aseptic placement of the devices, with minimal tissue damage and loss of insulating pelage. Absorbable monofilament suture (polydioxanone) was used in a buried 3-layer closure of surgical incisions. The incisions healed rapidly and without complications.     

Comparison of Adhesive Polyurethane Membrane and Polypropylene Sutures for Closure of Skin Incisions in Cats

Paired skin incisions were made on each side of four cats and closed with either interrupted polypropylene sutures or adhesive polyurethane membrane. The healing of these wounds was compared by gross appearance, break strength determination, and histologic examination. The adhesive polyurethane membranes were quicker and easier to apply, producing a more uniform closure than sutures both clinically and histologically. They adhered strongly to the skin, supporting more wound length than sutures for the first 7 days. There were no differences in break strength between closure techniques. Histologically, the wounds closed with adhesive polyurethane membrane were characterized by a milder inflammatory reaction and greater vascular infiltration than sutured wounds, especially early in the healing period.