of a gauze over the end of the suction tip so it is not able to suck up tissue.
Figure 1.8 Hold the instruments like a pen (a) and not across the palm (b) for better control and the ability to roll the instrument.
Figure 1.9 The basic microsurgical pack should consist of a needle holder, scissors, and forceps.
Figure 1.10 Ophthalmic bulb syringe is useful for irrigation in small patients.
References
1 Bennett, R.A. (2009). Rodents: soft tissue surgery. In: BSAVA Manual of Rodents and Ferrets (eds. E. Keeble and A. Meredith), 73–79. Gloucester: British Small Animal Veterinary Association.
2 Davids, B.I., Davidson, M.J., Tenbroeck, S.H. et al. (2015). Efficacy of mechanical versus non‐mechanical sterile preoperative skin preparation with chlorhexidine gluconate 4% solution. Veterinary Surgery 44 (5): 648–652.
3 Harkness, J.E. (1993). Anesthesia, surgery. In: A Practitioner’s Guide to Domestic Rodents (ed. J.E. Harkness), 37–50. Denver, CO: American Animal Hospital Association.
4 Harkness, J.E., Turner, P.V., VandeWoude, S., and Wheeler, C. (2010). Harkness and Wagner’s Biology and Medicine of Rabbits and Rodents, 5e. Ames, IA: Wiley‐Blackwell.
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6 Jenkins, J.R. (2000). Surgical sterilization in small mammals. Spay and castration. Veterinary Clinics of North America: Exotic Animal Practice 3: 617–627.
7 Maxwell, E.A., Bennett, R.A., and Mitchell, M.A. (2018). Efficacy of application of an alcohol‐based antiseptic hand rub or a 2% chlorhexidine gluconate scrub for immediate reduction in the bacterial population on the skin of dogs. American Journal of Veterinary Research 79 (9): 1001–1007.
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9 Skorupski, A.M., Zhang, J., Ferguson, D. et al. (2017). Quantification of induced hypothermia from aseptic scrub applications during rodent surgery preparation. Journal of the American Association for Laboratory Animal Science 56 (5): 562–569.
10 Verwilghen, D., Grulke, S., and Kampf, G. (2011). Presurgical hand antisepsis: concepts and current habits of veterinary surgeons. Veterinary Surgery 40: 515–521.
2 Suture Materials
Michael S. McFadden
Introduction
Suture materials play an important role in veterinary surgery, but many veterinarians overlook important details and try to use one suture material for too many applications. Most veterinarians with no postgraduate training in surgery select suture materials based on hospital policy or cost, whereas veterinarians with postgraduate training in surgery select suture material based on a more complete understanding of suture materials and indications. The ideal suture would be in place only as long as needed and would then immediately disappear. Tissues heal at different rates, so materials that are more slowly absorbed are best used only in tissues that take a long time to heal. Suture should cause minimal tissue reaction, and the surgeon should attempt to minimize the amount of suture buried because all suture is foreign material. The amount of inflammation caused by different suture materials is illustrated in Figure 2.1. With the exception of rodents and rabbits, there are relatively few studies specifically examining suture materials in exotic animals.
Suture Materials
The role of sutures is to maintain incised or injured tissue in apposition to allow the tissue to heal (Bellenger 1982; van Rijssel et al. 1989; Roush 2003). The ideal suture material would provide high tensile strength for a sufficient time to allow the tissue to heal, have good knot security, resist infection, and cause no inflammatory, immunogenic, or carcinogenic reactions. The reaction of tissue to sutures depends on several variables such as the type, quantity, and duration of suture implantation as well as the tissues into which suture is implanted.
Surgeons must be familiar with different suture materials in order to make the most appropriate choice for specific clinical situations (Ratner et al. 1994). It is important to have a thorough understanding of the tissues, healing time required, the time the suture retains sufficient tensile strength to support the tissues as they heal, and time to complete absorption. The suture that is chosen may affect wound healing, functional outcome, and cosmetics. The number of suture types available has increased dramatically, and each suture type has specific physical, handling, and tissue reaction characteristics. Sutures are classified in many ways based on their ability to be absorbed and whether they are single, stranded, or braided. Different suture properties can also affect the knot security which must also be considered when choosing suture materials (Marturello et al. 2014).
Absorbable Suture Materials
Absorbable suture materials are defined as materials that lose their tensile strength within 60 days of implantation (Tan et al. 2003). These sutures are either composed of different synthetic polymers or are of biologic origin. Absorbable sutures that are biologic in origin are broken down by phagocytosis, while synthetic polymers are absorbed by hydrolysis. Hydrolysis involves breaking down polymers into monomers by direct water cleavage, and the monomers are then absorbed and metabolized by the body (Tan et al. 2003). Common absorbable sutures include chromic gut, polydioxanone (PDS™, Ethicon Inc., Cincinnati, OH), poliglecaprone 25 (Monocryl™, Ethicon Inc., Cincinnati, OH), polyglactin 910 (Vicryl™, Ethicon Inc., Cincinnati, OH), polyglyconate (Maxon™, Covidien, Medtronics, Minneapolis, MN), synthetic polyester called Glycomer™ 631 (Covidien, Medtronics, Minneapolis, MN) comprised of glycolide (60%), dioxanone (14%), and trimethyelene carbonate (14%) (Biosyn™, Covidien, Medtronics, Minneapolis, MN), polyglycolic acid (Dexon™, Covidien, Medtronics, Minneapolis, MN), polyglytone 6211 (Caprosyn™, Covidien, Medtronics, Minneapolis, MN), and synthetic polyester called Lactomer™ comprised of a copolymer of glycolide and lactide (Polysorb™, Covidien, Medtronics, Minneapolis, MN).
