surgical implants
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Questions and Answers

What is a potential patient factor that can negatively impact surgical healing in cats?

  • Consuming a high protein diet
  • High energy levels
  • Regular exercise routine
  • Underlying disease like Cushings (correct)
  • Which of the following is a considered surgical factor that can lead to complications?

  • Using the correct suture material
  • Failure to incorporate fascia (correct)
  • Using sufficient suture throws
  • Maintaining aseptic technique
  • What could indicate an underlying issue during the surgical evaluation of a cat?

  • Minimal swelling after incision
  • Residue from previous surgeries
  • Fluid in the abdomen at initial surgery (correct)
  • Increased appetite post-surgery
  • What is an important consideration in suture placement during surgery?

    <p>Using polyglactin 910 (Vicryl) is preferable (A)</p> Signup and view all the answers

    What is the appropriate surgical approach for a cat diagnosed with calcium oxalate crystals?

    <p>Cystotomy (C)</p> Signup and view all the answers

    What type of suture material is preferred for use in stays to suspend the bladder?

    <p>Synthetic absorbable material like polydioxanone (A)</p> Signup and view all the answers

    Which suture pattern is recommended for achieving a watertight closure?

    <p>Cushing (A)</p> Signup and view all the answers

    What is the absorption time for Poliglecaprone 25 (Monocryl)?

    <p>91-119 days (A)</p> Signup and view all the answers

    Which is a disadvantage of using Poliglecaprone 25 as a suture material?

    <p>It is not suitable where prolonged strength is required. (A)</p> Signup and view all the answers

    What can be used to hold an oesophagostomy tube in place?

    <p>Synthetic absorbable sutures (A)</p> Signup and view all the answers

    What significant concern is there when using the Connell suture pattern?

    <p>It may include suture in the bladder lumen. (C)</p> Signup and view all the answers

    What is an advantage of using a two-layer closure technique?

    <p>It offers better protection against contamination. (C)</p> Signup and view all the answers

    Why should one avoid using multifilament sutures in the bladder area?

    <p>They increase the risk of infection. (D)</p> Signup and view all the answers

    What is the initial introduction of the needle for during the suturing process?

    <p>For simple interrupted suturing (B)</p> Signup and view all the answers

    Which layer is NOT mentioned as part of the three-layer closure for the abdomen?

    <p>Peritoneum (A)</p> Signup and view all the answers

    Which suture characteristic is categorized as non-absorbable?

    <p>Synthetic monofilament (D)</p> Signup and view all the answers

    What might be a reason for a suture to hang from a wound in a speyed cat?

    <p>Incorrect suture technique (B)</p> Signup and view all the answers

    Which of the following sizing guides corresponds to a 3/0 suture?

    <p>2 mm (C)</p> Signup and view all the answers

    Where was the simple continuous suture pattern used in the described case?

    <p>Line alba (C)</p> Signup and view all the answers

    Which of the following is NOT a type of suture material mentioned?

    <p>Synthetic continuous (D)</p> Signup and view all the answers

    What is a potential patient factor that could lead to complications with sutures after surgery?

    <p>Age of the patient (C)</p> Signup and view all the answers

    What is the primary purpose of the Chinese Finger Trap Suture?

    <p>To secure tubes exiting the body (A)</p> Signup and view all the answers

    Which of the following is NOT a type of feeding tube mentioned?

    <p>Intestinal tube (D)</p> Signup and view all the answers

    How is a gastropexy relevant in the context of feeding tube placement?

    <p>It fixes the stomach to the body wall following torsion. (C)</p> Signup and view all the answers

    What appearance does gas have on an x-ray of a normal stomach?

    <p>Black (B)</p> Signup and view all the answers

    What is the finish technique for the Chinese Finger Trap Suture?

    <p>A square knot (D)</p> Signup and view all the answers

    What additional application can gastrostomy tubes have beyond feeding?

    <p>Gastropexy (A)</p> Signup and view all the answers

    What aspect of a normal stomach is indicated by the presence of gas on an x-ray?

    <p>Normal function (C)</p> Signup and view all the answers

    Which feeding tube is specifically mentioned as being left-sided for feeding?

    <p>Gastrotomy tube (B)</p> Signup and view all the answers

    What is the purpose of performing a gastropexy in cases of gastric torsion?

    <p>To surgically de-rotate and fix the pylorus to the body wall (C)</p> Signup and view all the answers

    Which suture material is most commonly used in surgical procedures mentioned?

    <p>2/0 or 3/0 suture material (D)</p> Signup and view all the answers

    What visual indication might suggest gastric dilation in imaging?

    <p>Black gas visible in the stomach (A)</p> Signup and view all the answers

    What is the primary function of a purse string suture?

    <p>To close a hollow viscous around a structure (C)</p> Signup and view all the answers

    Which technique is NOT listed as a method for performing gastropexy?

    <p>Free-hand gastropexy (C)</p> Signup and view all the answers

    What complication could arise if a gastropexy is not performed correctly?

    <p>Recurrent gastric torsion (C)</p> Signup and view all the answers

    What unique shape does the duodenum form during a gastric torsion event?

    <p>Popeye’s arm shape (B)</p> Signup and view all the answers

    In what scenario is an ameroid constrictor used?

    <p>To manage blood flow in surgeries (A)</p> Signup and view all the answers

    What is the primary reason George is vomiting?

    <p>He ingested sharp stones. (C)</p> Signup and view all the answers

    Which suture material is non-absorbable and poor for intestinal repair?

    <p>Prolene-polypropylene (B)</p> Signup and view all the answers

    How long does it take for Vicryl/Polyglactin 910 to lose 50% of its strength?

    <p>21 days (D)</p> Signup and view all the answers

    Which of the following properties is true for PDS Polydioxanone?

    <p>It has high memory but less drag. (C)</p> Signup and view all the answers

    Which suture type is most suitable for intestinal anastomosis?

    <p>PDS Polydioxanone (A)</p> Signup and view all the answers

    Why is Chromic cat gut not suitable for intestinal anastomosis?

    <p>It requires a swaged needle. (C)</p> Signup and view all the answers

    What is a disadvantage of using multifilament materials like Vicryl?

    <p>They can wick bacteria due to their braided nature. (B)</p> Signup and view all the answers

    What characteristic of Prolene-polypropylene makes it a poor choice for intestinal repair?

    <p>It has poor handling and high memory. (B)</p> Signup and view all the answers

    What happens to the strength of Chromic cat gut in the presence of infection?

    <p>It loses strength more rapidly. (D)</p> Signup and view all the answers

    What is the time to total absorption for PDS Polydioxanone?

    <p>180 days (B)</p> Signup and view all the answers

    Study Notes

    Implanted Materials Live Session

    • Alison Livesey, October 2024

    Case Study 1: George the Labrador

    • One-year-old male
    • Vomiting for one week
    • Has not eaten anything in a week
    • Frequently eats stones
    • Admitted for radiographs showing a foreign body in the intestines
    • Suspected exploratory laparotomy due to sharp object and potential perforation
    • To be stabilized and taken to surgery following stabilization.

    Suture Materials and Considerations

    • Suitability of suture materials for enterotomy/enterectomy
    • Neighbor- absorbable? Non-absorbable?
    • Needle type and size
    • Suture pattern (monofilament/multifilament)

    Prolene-Polypropylene

    • Synthetic material, non-absorbable
    • Long-term strength retention
    • Poor handling, high memory
    • Not suitable for intestinal repair
    • Reverse cutting needle not suitable

    Vicryl/Polyglactin 910

    • Synthetic braided/multifilament material, absorbable
    • Absorption time: 56-70 days
    • Loss of strength occurs over the time period of absorption
    • Used for ligation/tissue approximation
    • Braided structure is more likely to wick bacteria
    • Reverse cutting needle not suitable

    Chromic Cat Gut

    • Natural material/absorbable
    • From cattle/sheep mucosa & submucosa
    • Excellent handling, but can elicit a foreign body reaction.
    • Loss of strength occurs over the time period of absorption
    • Full absorption occurs in 42 days
    • Loses strength more rapidly if infection is present
    • Not suitable for intestinal anastomosis
    • Swaged needle needed for anastomosis

    PDS Polydioxanone

    • Synthetic absorbable monofilament
    • Less wicking than multifilament
    • High memory
    • Useful where prolonged support required
    • Predictable absorption time: 180 days
    • 14-20% loss at 14 days, 41%-50% loss at 42 days, 86% loss at 56 days
    • Round-bodied needle

    Needle Evaluation

    • Problematic needle examples shown on slides
    • Requirements for proper needle shape and fixation (swaged needle)

    Suture Patterns for Enterotomy/Enterectomy

    • Simple interrupted or continuous patterns suitable for enterotomy/enterectomy.

    Patient Considerations for Surgery

    • Hypovolemia
    • Hypoproteinaemia
    • Hypothermia
    • Break in asepsis
    • Contaminated procedure and spillage
    • Analgesia
    • Halsted's principles (aseptic technique, preserving blood supply, minimized tension, accurate tissue apposition, minimized dead space, haemostasis)

    Surgery on George

    • Removal of sharp pebble (foreign body) and successful end-to-end resection performed.

    Wound Classification

    • Categories include clean, contaminated, and dirty. Different wound classifications.

    Case Study 2: Two-year-old Female DSH Cat with Suture Issue

    • Owner noted suture hanging from wound following midline spay.
    • Simple continuous pattern was used in the linea alba during prior surgery.
    • Potential patient factors (immune system, hydration, co-morbidities)
    • Potential surgical factors influencing suture failure (wrong size/type of material, incorrect suture pattern, improper placement).
    • Cat had fluid in the abdomen, suggesting another underlying cause for the issue.

    Case Study 3: Three-year-old MN Shih Tzu

    • Grade 3 patellar luxation surgery 4 weeks prior.
    • Tibial tuberosity transposition.
    • Swelling developed over stifle following the operation.
    • Corrective measures needed.

    Case Study 4: Four-year-old FN DSH Cat

    • Urinary straining, hematuria, and presence of calcium oxalatecrystals.
    • Radiographs reveal calculus in the bladder.
    • Cystotomy procedures

    Suture Material for Cystotomy

    • Stay sutures to suspend the bladder and prevent abdominal contamination.
    • Synthetic absorbable material (polydioxanone/polyglactin) 25/3/0 or 4/0 (1.5/2 metric).
    • Two-layer closure recommended if possible.
    • Inverting suture for water-tight closure.

    Inverting Suture Patterns

    • Lembert
    • Connell
    • Cushing
    • Detailed techniques illustrated on images.

    Polyglactin 25 (Monocryl) Sutures

    • Synthetic absorbable
    • Monofilament
    • Rapid absorption: 91-119 days.
    • Quicker loss of strength than polydioxanone.
    • 30-50% strength loss at 7 days.
    • Knot security less reliable than multifilaments.

    Case Study 5: Stray Persian Cat After RTA

    • X-rays revealed no abdominal injuries
    • Further investigations needed for possible concealed injuries

    Radiograph Interpretation

    • Determining anatomical structures or foreign bodies from X-Ray images

    Sub-Ureteral Bypass Procedure

    • Description of the procedure
    • Use for repair of ureteral damage
    • Illustrative images of the procedure presented

    Case Study 6: Charlie-4 year old female Pointer

    • Not eating for a week
    • Diagnosis of pancreatitis
    • Procedure requires oesophagostomy tube placement.
    • Suture needed to hold the oesophagostomy tube in place

    Chinese Finger Trap Suture

    • Description of the procedure
    • Uses to secure tubes (drains/feeding)

    Feeding Tubes

    • Nasogastric tubes
    • Oesophagostomy tubes
    • Gastrotomy tubes

    Normal Stomach

    • Features of a normal stomach on x-ray and images

    Gastric Dilation

    • Diagnostic indicators
    • Images illustrating presence of stomach and/or gas

    Gastric Torsion

    • Description of the anatomical rotation of organs in the digestive system
    • Treatment techniques for gastric torsion.
    • Suture types frequently employed for gastropexy

    Purse String Suture

    • Temporary closure used for structures like the anal region.
    • Securing tubes

    Implant Problems in Animals

    • Identification of possible issues with implant, such as infections
    • Images illustrating potential complications

    Ameroid Constrictor

    • Medical device for controlling the size of an internal anatomical structure, such as in the digestive system.

    Summary of Suture Characteristics

    • Summary of suture classifications (absorbable/non-absorbable, synthetic/natural, monofilaments/multifilaments).
    • Important properties and considerations regarding suture selection.

    Size Guides

    • Conversion between metric and USP sutures

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