Saturday, July 30, 2011

526. Four packets of stitches to spay a female dog is extravagance

Best Time To Spay Your Female Dog
- A Dream Spay
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Case written: 23 November, 2007
Update:  31 July, 2011

When the dog owner is well informed, a spay operation in the female dog can be a very smooth operation taking less than 30 minutes.

Today was such a day. The Miniature Schnauzer, born in Dec 3, 2005 was on heat 4 months ago. She was spayed today Nov 23, 2007 as the owner was advised to do so 3-4 months after heat and she made the appointment at the 4th month.

My assistant Mark talked to the dog as he put the face mask over her muzzle. She did not struggle and went to sleep under 8% gas anaesthesia within 10 minutes. No tranquilisation was needed. I inserted the endotracheal tube to connect her lungs to the anaesthetic machine, maintained the anaesthesia at 1.5%.

The incision was 2.5 cm from the umbilicus. A 1-cm cut into the skin and the linea alba to access the internal organs of the womb and ovaries. I inserted the spay hook into the abdomen by turning it towards my right at 45 degrees caudally.

It hooked out the left uterine horn. I pulled the left ovarian ligament. The dog started to breath much faster as she felt the pain. My assistant increased the gas to 8% for a minute so that the dog had more gas to remove the pain of surgery. The minimal amount of gas given will lead to no deaths and that was why I used 1.5%.

No more rapid breathing observed. I cut the ovarian ligament with the scalpel. Clamped the ovarian stump. Ligated the stump. Then I pulled the left uterine horn totally out of the body and saw the right uterine horn at the uterine body junction popping out. I used forceps to pull it out.

From there, I accessed the right ovarian ligament and repeated the same procedure as with the left. No bleeding. The blood was normal red with oxygen. The dog was breathing regularly. Finally, I took out the uterine body, clamped and ligated it. It was let go into the abdomen.

The skin and muscles were stitched up. The gas anaesthesia was switched off as I stitched the skin. No bleeding from the ovarian and uterine tissues at all as the dog was no longer on heat.

The dog woke up smoothly after 3 minutes. An Elizabeth collar was given to prevent licking of wound. Overall, this was a dream spay. It was the most satisfying spay I had ever done as everything proceeded smoothly, there was no bleeding and therefore the surgical time taken was less than 30 minutes. The dog woke up by the last stitch as I had the gas reduced to 0% during stitching which is usually one horizontal mattress stitch. She went home without complications post-operation as the owner did not phone me nor came for stitch removal, thus saving time for him.

1. Bathe the dog? Yes, but make sure the plaster is not wet.
2. Can the dog eat any food? Yes.
3. When to come back to remove the stitches. No need. The absorbable stitches will dissolve and fall off in 14-28 days.
4. When to remove plaster? 7 days later.
5. Can give antibiotic and pain-killer tablets crushed and mixed with water inside a syringe? Yes.

A new isoflurane vaporiser has been installed in July 2011. Maximum is 5%. The dog is usually sedated with xylazine or domitor before isoflurane gas is given by mask and then intubation.

For dogs in general, I find that one packet of 2/0 absorbable sutures is sufficient, even for big breeds like the Siberian Husky. From my over 30 years of spaying dogs, I find that there is no need to do a subcuticular sutures. One horizontal mattress suture closes the skin as shown below.

There are employee vets who use two packets to spay a female dog as they don't need to account for the bottom-line.

In July 2011, I discovered a vet who used 4 packets of sutures (2 packets of "0" chromic catgut and 2 packets of "3/0" absorbable monofilament) for pyometra surgery in a Maltese. This is extravagance from this vet who does not have to pay for the sutures herself. There is a need for a new vet to be prudent and to keep surgery simple and safe for the dog. In this case, 2 packets of sutures will be more than sufficient and that will be the industry's bench mark.

Keep spay simple for the dog by using minimal suturing. Less sutures mean less irritation and itchiness during healing. There is no need for subcuticular sutures. If you feel the need to impress the client by using "subcutaneous" sutures (sutures under the skin) so that the client does NOT see any sutures on the skin, you need to have excellent stitching skills. No point showing the sutures or stitching another appositional layer if you want to impress the client.

A RARE CASE OF PYOMETRA IN A VERY YOUNG FEMALE DOGPyometra in a very young female Silkie Terrier is very rare as this womb infection occurs usually in female dogs over 5 years of age. By spaying her, the owner prevents pyometra which can cause death in some female dogs.

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