Saturday, October 22, 2011

Keep Spay Surgery Simple - No subcuticular suturing

I am writing to share my over 30 years of experiences in spaying dogs and cats done by me and by other vets in Toa Payoh Vets.

I started Toa Payoh Vets in 1982 and it is 2011 now. I have seen a few cases of stitch breakdown using the method as advised by the university professors and veterinary surgery text books (Method 1).

The vet university professors since my time in 1974 when I graduated from Glasgow University and even recently in Australian Universities, advocate the following steps after removing the ovaries and uterus:

1. suture the linea alba
2. suture the subcutaneous fat to seal up dead spaces
3. suture the skin
The theory is sound and many newly graduated vets adopt this system (Method 1). Over the years, I encountered a few cases of stitch breakdown and infection in dogs and cats using Method 1 done by other vets. Or intense redness and inflammation at the surgical area.

My method does NOT use Step 2 and I have less than 1% of post-op stitch breakdown. I have no figures to substantiate my claim. I am merely sharing my experiences as I am in my retirement era, being 61 years of age.

I just hope that this knowledge may benefit the dogs and cats. In the early years of 1970 - 1980, I did not prescribe pain-killers unlike nowadays and I don't have many post-op spay problems. Times have changed. Pain-killers inclusive of antibiotics are a must.

There are many reasons for stitch breakdown but one of them is the irritating subcutaneous suture. The dog or cat keeps licking the wound or just use the hind paws to scratch it. E-collars do not help much. Soon, the unhappy owner brings in the dog or cat for review.

In private practice, the vet earns his reputation by not getting less or no post-op spay stitch breakdown as owners will compare and complain. Obviously, in other surgery like breast tumour removal, subcuticular sutures are needed to close the dead spaces. I use "walk-in" sutures. This involves suture needle going into the skin, then into the subcutaneous fat and out of the subcutaneous fat, then out of the skin on the other side. From there, I transverse, needle goes into the skin, subcutaneous fat and out from the initial side. This makes for a horizontal mattress skin suture as seen from the skin. In this method, surgical time is reduced, unlike separate subcuticular sutures of the subcutaneous fat. See case report at:
http://www.bekindtopets.com/dogs/20081235Mastectomy_Female_Dog_ToaPayohVets.htm

Then simple interrupted sutures of the skin as this is a usual method by many vets.

The two methods of SPAY IN THE DOG AND CAT are illustrated by real cases as follows:

METHOD 1 - BY THE (VETERINARY SURGERY) BOOK



1298. Subcuticular sutures have been used. The stitches under the skin hinder healing due to infections or traumatic injury from licking.
1299. Stitch breakdown and infection. Re-stitch again but no more subcuticular suturing.
METHOD 2 - BY DR SING



1296. A spay hook enables the vet to make spay incision small in the dog and cat.
1297. Dr Sing's dog spay procedures. No subcuticular sutures.
All the years, I use absorbable PDS sutures and this means the owner does NOT need to return for stitch removal. I just use one packet of sutures. However, with Method 1, I note that some of the younger vets must use two packets and sometimes three packets in dogs that are pregnant and of bigger breeds.

I have seen cases where a vet uses 3 packets of sutures to spay a medium sized dog. This is definitely too many. One packet is chromic catgut. Two packets of absorbable monofilament. With my method, one packet of absorbable suture is sufficient for dogs up to medium size, using the spay hook.

Keep spay simple. I hope this report is of use to some practising vets. It cuts down on expenses in using more sutures and in private practice, costs keep rising as bureaucrats think of ways and means to generate income from the industry by increasing regulatory fees. Keeping spay simple and using walk-in sutures make economic sense as well as keep owners of dogs and cats happier.

OTHER INFORMATION




4448. KPI - How long it takes to spay a female dog? 26 or 18 minutes?
4451. Surgery Audit: How long it takes to spay a female dog? 18 minutes


4438 - 4444. When do you remove the dressing or stitches after spay/neuter?
4475. Never discharge a spayed dog with a hole in the operation area
 
Toa Payoh Vets webpage is at:
http://www.sinpets.com/F6/20111033spay-cat-dog-no-subcuticular-singapore-toapayohvets.htm

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