Considerations for Selection of Suture Materials

The selection of a suture material, in the past, was based primarily on habit, guesswork and physical properties. This is understandable because there was a limited number of materials to select from and the interaction of suture material with tissues was not understood.     

Preparation and equipment useful for surgery in small exotic pets.

Because many exotic pets are so small, the instrumentation and equipment used for surgery are different from in larger animals. Magnification greatly improves the surgeon's ability to accomplish surgeries in small patients and helps to provide hemostasis because small amounts of blood are significant in these tiny patients. Microsurgical instrumentation is important to allow for proper tissue handling and suture placement. Various other considerations, instrumentation, and equipment are useful when performing surgery on small exotic pets.     

Suture sinus in the linea alba of two dogs

Suture sinuses developed in the linea alba of two dogs, associated with monofilament, nonabsorbable suture material. Knot bulk and irritation was thought to be the most important factor in sinus development in one dog, while infection was thought the most important factor in the other dog. Both dogs responded to aggressive surgical resection of the affected tissue and the offending suture. The factors responsible for suture sinus formation and the management of such are discussed.     

Vitamin D and Ultraviolet B Radiation Considerations for Exotic Pets

Vitamin D is an essential hormone that regulates many different functions in vertebrates and can have a protective effect against various disease conditions. Providing exotic pets appropriate access to vitamin D, through the diet, ultraviolet B (UVB) exposure, or a combination of both, is important for veterinarians and exotic pet owners to consider. Although it is commonly thought that most animals derive the vitamin D they need through their diet, there are a number of species that appear to benefit more from UVB exposure. In addition, there has been minimal study to investigate appropriate dietary levels of vitamin D for many of our exotic pets. Although the recommendation of providing UVB lighting has been primarily limited to captive reptiles, research with other species (e.g., birds and small mammals) suggests that these animals may also benefit from this type of lighting. However, the provision of UVB is not without its potential side effects. The purpose of this article is to review the important roles of vitamin D in animals, the different methods animals use to acquire this hormone, the potential clinical signs associated with hypovitaminosis or hypervitaminosis D, the role of artificial UVB lighting in the synthesis of vitamin D, and the potential side effects associated with UVB radiation.     

Response of Canine Synovial Membrane to Three Different Types of Suture Material

The synovial tissue response to three different suture materials was assessed in nine dogs. Stifle joint arthrotomies were sutured with either chromic gut, teflon coated polyester suture, or polypropylene suture; all joint capsule layers were penetrated, exposing the suture material to the joint cavity. The synoviocytic and subsynviocytic layers at the arthrotomy site were examined histologically one, two, and three weeks following surgery. Chromic gut caused the greatest cellular inflammatory response and polypropylene the least. Teflon coated polyester and chromic gut were associated with nearly the same degree of tissue fibrosis. Polypropylene was associated with much less fibrosis than the other suture materials.     

Effects of Nylon and Polyglactin 910 Suture Material on Perilimbal Corneal Wound Healing in the Dog

The effects of fine suture materials on corneal wound healing in the dog were studied. In 20 dogs, standardized perforating perilimbal clear corneal wounds were made and closed with either monofilament Polyglactin 910 or nylon. Five dogs each were euthanized 8,12,16, and 21 days postoperatively. Results of gross, biomicroscopic, and histologic examinations at 8,12,16, and 21 days showed nylon and Polyglactin 910 to cause similar inflammatory responses. Epithelialization and suppuration around the suture tracts were observed more frequently when Polyglactin 910 was used. Both materials were associated with a foreign body (granulomatous) response. There was no loss of wound integrity with either material. Strengths of the incised corneal tissues with and without the sutures intact were determined. At day 16 postsurgery, there was a statistically significant difference in tissue strengths between cases in which sutures were and were not intact. This difference was not apparent at 21 days postsurgery, which suggested that the suture dependent phase ends between the 16th and 21st postsurgical days. In addition, at day 16 there was no statistical difference between the tissue strength of wounds sutured with nylon or Polyglactin 910. Corneal suture materials studied should remain in place for at least 16 days, and absorbable material is only appropriate if it retains tensile strength for 16 days.     

Principles of neurological imaging of exotic animal species.

Because the central nervous system (CNS) is encased almost entirely in bone, the means by which the clinician can evaluate it are limited. Additionally, the small size of many exotic companion animals further complicates diagnostic evaluation of the brain and spinal cord. Knowledge of the advantages and limitations of different imaging modalities, along with the neuroanatomical localization and assessment of likely causes of disease, will permit the clinician to choose the most appropriate imaging method for the patient. This article discusses the basic imaging principles of radiology, myelography, CT, and MRI of the nervous system of companion exotic animals to aid exotic animal clinicians in selecting imaging modalities and interpreting the results.     

Clinical Experience With Polydioxanone Suture Material

Polydioxanone (PDS™) synthetic absorbable suture material was evaluated in 169 dogs and cats. Sutures or ligatures were used on 446 tissues including 18 contaminated and 16 infected wounds. There was less tissue friction than with polyglycolic acid or polyglactin 910 sutures. The suture tended to kink during placement of continuous suture patterns. There was one wound dehiscence.
Polydioxanone may be used wherever surgical gut, polyglycolic acid, or polyglactin 910 sutures are normally used.     

Suture materials: composition and applications in veternary wound repair

Suture materials play an important role in veterinary surgery by providing support for healing tissues during wound repair. As there is no single ideal suture material, clinicians must compromise on some properties when selecting a material for a specific purpose. By reviewing the characteristics of absorbable and non-absorbable materials, general recommendations can be made on their usage in skin, fascia, viscera and other tissues.     

Emergency Presentations of the Exotic Small Mammalian Herbivore Trauma Patient

Trauma is a common complaint by owners of small exotic mammalian herbivores (e.g., rabbits, rodents) presented to veterinary hospitals. The term “trauma” is a broad disease category applied to patients with physical debilitation associated with injury often classified as “blunt,” “penetrating,” or “burn” in origin. Because many small exotic mammalian herbivores are prey animals, clinical signs of trauma may be masked until the effects of the injury outweigh the innate nature to survive. Small exotic mammalian herbivores are disproportionately sensitive to stress; thus, pain management and supportive care are extremely important during the initial stages of trauma management. Small exotic mammals differ slightly from other companion animals (e.g., dogs, cats) in regard to common trauma presentations. However, with a few therapeutic modifications (e.g., antibiotic selection, avoidance of corticosteroids, preventing self-trauma), treatment of small exotic mammalian herbivore trauma cases follows the same conventional guidelines used for other companion animals.     

Le choix d'un matériel de suture

This review summarizes the physical properties of the most frequently used suture materials. It also describes the different healing processes involved in various tissues and discusses the main points of consideration in the proper selection of a suture material.     

Transfusion medicine in exotic pets

The decision to transfuse a patient should always be based on the packed cell volume and clinical status of the patient. This article discusses indications for transfusion and blood substitutes in exotic animal patients. The administration of blood products requires careful donor selection, knowledge of blood groups, cross-matching, and use of anticoagulants. Collection sites, volume, and administration techniques are given for different species of animals including birds, rabbits, and ferrets. Blood-transfusion therapy is not without risk. The frequency with which transfusion reactions occur in exotic pets is unknown. The most common transfusion reactions seen in small animals, along with suggested treatment, are discussed. The availability of blood products is limited in exotic pet medicine; therefore, the use of blood substitutes (Oxyglobin) has the advantage of long storage potential, no need for cross-matching, and no potential for disease transmission. General principles of blood substitutes and administration techniques will be discussed.     

Locking Loop Tendon Suture Use in Repair of Five Calcanean Tendons

The locking loop tendon suture is demonstrated. Five cases of its use in both acute and chronic lacerations of the calcanean tendon are presented. The results in all five cases were excellent. Advantages of this suture pattern include preservation of the intrinsic blood supply of the tendon, gap formation produced only with extreme load, simple and rapid placement of the suture, and reduction in adhesions. This suture pattern also can be used for other tendons.     

Strength Characteristics and Failure Modes of Suture Patterns in Severed Goat Tendons

The load-to-gap formation, maximum load, gap present at maximum load, and failure mode were compared among four suture patterns: Bunnell-Mayer, modified Kessler, Mason-Allen, and simple interrupted. Sixty-four goat tendons were sutured with 2-0 monofilament polypropylene in one of the patterns and distracted at 92 cm/min with an electrohydraulic materials testing system. All tests were filmed at 40 frames/sec with an intermittent pin registered camera. The load-to-gap formation was not significantly different among the Bunnell (13.3 +/- 1.5 newtons [N]), Kessler (12.8 +/- 1.3 N), and simple interrupted (11.7 +/- 1.7 N) patterns. The Mason-Allen pattern was significantly different )8.2 +/- 0.5 N). The Bunnell-Mayer had the highest mean maximum load to failure (43.0 +/- 1.6 N) followed by the modified Kessler (34.1 +/- 1.9 N). There was no difference between the Mason-Allen (22.9 +/- 1.4 N) and simple interrupted (21.2 +/- 1.4 N). All of the patterns permitted at least a 1 cm gap to form when the maximum load was applied. The Bunnell pattern caused severe constriction of the tendon and failed by suture material disruption. The modified Kessler caused some focal constriction, but the suture material pulled out before breaking and sliced the tendon in the process. The Mason-Allen and the simple interrupted patterns sliced the tendon as the suture pulled out of the tendon.     

Diagnostic testing for fungal diseases.

Fungal infections can be challenging to diagnose, and accurate interpretation of laboratory data is important to ensure the most appropriate treatment for the patient. An overview of the nonspecific diagnostic aids and specific fungal diagnostics is presented. Additionally, a brief summary of the role of free-living saprophytes and pathogenic dimorphic fungi is discussed in relation to exotic animals seen in veterinary practice. The important fungal diseases are reviewed with reported prevalence, hosts and with specific diagnostic testing recommendations.     

The Effect of Six Knotting Methods on the Biomechanical Properties of Three Large Diameter Absorbable Suture Materials

Objective— To evaluate the effect of 6 different knotting methods on the mechanical properties of 3 large absorbable suture materials used in large animal surgery. Study Design— In vitro mechanical study. Sample Population— Knotted suture loops (n=15 per group). Methods— Suture loops were created between two low‐friction pulleys with either 2 polydioxanone, 2 polyglactin 910 or 3 polyglactin 910. Strands were tied using 1 of 6 knotting technique: square knot, surgeon knot, clamped surgeon's knot, sliding half‐hitch knot (HH), Delimar knot and self‐locking knot (SLK). A single cycle to failure test was performed on each suture loop with a distraction rate of 100 mm/min. Failure modes were evaluated and breaking strength, elongation to failure and stiffness were compared. Results— All loops except two HH failed at the knot by acute breaking. The double‐stranded SLK was both stronger and stiffer than all other knots for each suture material. Clamping the first throw of the surgeon knot decreased load to failure significantly (143.11 ± 8.64 N) compared with not clamping (159.21 ± 6.14 N) for polydioxanone. Stiffness and elongation to failure were respectively lower and increased for 2 polydioxanone compared with both polyglactin 910 materials for all knotting techniques. Conclusions— Knotting techniques do influence structural properties of suture loops. The double strand loop conferred stiffer and stronger properties to the SLK Clinical Relevance— Clamping the first throw of polydioxanone should be avoided when tying a suture under tension even using large diameter suture materials. Using a SLK might be considered as a useful alternative when excessive tension is present.     

Persistency of accuracy of genomic breeding values for different simulated pig breeding programs in developing countries

Genetic improvement of pigs in tropical developing countries has focused on imported exotic populations which have been subjected to intensive selection with attendant high population‐wide linkage disequilibrium (LD). Presently, indigenous pig population with limited selection and low LD are being considered for improvement. Given that the infrastructure for genetic improvement using the conventional BLUP selection methods are lacking, a genome‐wide selection (GS) program was proposed for developing countries. A simulation study was conducted to evaluate the option of using 60 K SNP panel and observed amount of LD in the exotic and indigenous pig populations. Several scenarios were evaluated including different size and structure of training and validation populations, different selection methods and long‐term accuracy of GS in different population/breeding structures and traits. The training set included previously selected exotic population, unselected indigenous population and their crossbreds. Traits studied included number born alive (NBA), average daily gain (ADG) and back fat thickness (BFT). The ridge regression method was used to train the prediction model. The results showed that accuracies of genomic breeding values (GBVs) in the range of 0.30 (NBA) to 0.86 (BFT) in the validation population are expected if high density marker panels are utilized. The GS method improved accuracy of breeding values better than pedigree‐based approach for traits with low heritability and in young animals with no performance data. Crossbred training population performed better than purebreds when validation was in populations with similar or a different structure as in the training set. Genome‐wide selection holds promise for genetic improvement of pigs in the tropics.     

Partial Maxillectomy in the Dog Comparison of Suture Materials and Closure Techniques

This study compares the healing of oronasal defects created by partial maxillectomy when closed using two different suture materials and two different suture patterns. In experiment 1, 24 dogs were divided into four equal groups. Partial maxillectomy was performed on each dog and was closed using either a two-layer simple interrupted suture pattern (12 dogs) or a modified Mayo mattress pattern (12 dogs) with either polyglactin 910 (12 dogs) or polypropylene (12 dogs) sutures. On the seventh postoperative day, the dogs were euthanized, suture line bursting pressures were measured, and wound healing was evaluated grossly and histopathologically. Suture line dehiscence occurred in one dog from each of the four groups. These were the only dogs in which electrocoagulation had been used. The healing of suture lines closed with the two-layer simple interrupted pattern was superior to that of those closed with the modified Mayo mattress pattern based on the degree of gross oral ulceration, suppurative inflammation, fibrosis and oral epithelial covering at the suture line, and the number of necrotic sites in the adjacent tissue. The healing of suture lines closed with polypropylene was superior to that of those closed with polyglactin 910 based on suture line bursting pressures and the degree of suppurative inflammation and tissue necrosis at the suture sites. In Experiment 2, partial maxillectomies were performed on four dogs, and closure was achieved using a two-layer simple interrupted suture pattern with either polyglactin 910 (two dogs) or polypropylene (two dogs). On the 30th postoperative day, the dogs were euthanized, and wound healing was evaluated grossly and histopathologically. All suture lines were well healed. All polyglactin 910 oral sutures were absent, while all polypropylene oral sutures were still present.