(2017). Adverse reactions to transfusion of blood products and best practices for prevention. Crit. Care Nurs. Clins. N. Am. 29: 271–290.14 14 Thomovsky, E.J. and Bach, J. (2014). Incidence of acute lung injury in dogs receiving transfusions. J. Am. Vet. Med. Assoc. 244 (2): 107–174.
15 15 Holowaychuk, M.K., Leader, J.L. and Monteith, G. (2014). Risk factors for transfusion‐associated complications and nonsurvival in dogs receiving packed red blood cell transfusions: 211 cases (2008–2011). J. Am. Vet. Med. Assoc. 244 (4): 431–437.
16 16 Tennent‐Brown, B. (2011). Plasma therapy in foals and adult horses. Compendium. 33 (10): E1–E4.
17 17 Beer, K.S. and Thomer, A. (2019). Massive transfusion. In: Textbook of Small Animal Emergency Medicine (ed. K.J. Drobatz, K. Hopper, E. Rozanski, et al.), 1156–1160. John Wiley & Sons.
18 18 Polkes, A.C., Giguere, S., Lester, G.D. et al. (2008). Factors associated with outcome in foals with neonatal isoerythrolysis (72 cases, 1988–2003). J. Vet. Intern. Med. 22 (5): 1216–1222.
19 19 U.S. Food and Drug Administration (2016). Fatalities reported to FDA following blood collection and transfusion: Annual summary for fiscal year 2016. Available at: www.fda.gov/media/111226/download.
20 20 Mudge, M.C., MacDonald, M.H., Owens, S.D. et al. (2004). Comparison of 4 blood storage methods in a protocol for equine pre‐operative autologous donation. Vet. Surg. 33 (5): 475–486.
21 21 Owens, S.D., Johns, J.L., Walker, N.J. et al. (2010). Use of an in vitro biotinylation technique for determination of posttransfusion survival of fresh and stored autologous red blood cells in Thoroughbreds. Am. J. Vet. Res. 71 (8): 960–966.
9 Complications Associated with Sutures
Ian F. Devick DVM, MS, DACVS‐LA1, and Dean A. Hendrickson DVM, MS, DACVS2
1 Weatherford Equine Medical Center, Weatherford, Texas
2 College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
Overview
Suture serves as a fundamental part of veterinary surgery and is mainly used for tissue apposition of a wound/incision and vessel ligation for hemostasis. The first known documented reference to suturing of a wound dates back to a papyrus from 1600 BC [1]. Obviously, since that time there has been enormous advances made in the development of suture materials, resulting in a vast number of different suture materials and sizes available to veterinarians today.
Briefly, suture material is classified by degradation behavior (absorbable vs. nonabsorbable), composition (natural vs. synthetic), and structure (monofilament vs. multifilament) [2]. Degradation behavior, composition, and structure along with suture surface characteristics and suture size influence additional suture characteristics, including flexibility, elasticity, capillarity, memory, tensile strength, knot holding capacity, and relative knot security [2]. There is no one suture material that is ideal for every situation and it is important for the veterinarian to understand the advantages and disadvantages of the different sutures physical and biological characteristics. However, it is equally important to understand the wound/incision location, tissue tension, contamination, vascular supply, and the healing rate of the given tissues when making the selection of an appropriate suture in the effort to decrease risk of suture‐related complications [3]. The cruciality of the proper surgical technique and the suture pattern selection for the given wound/incision, along with pertinent peri‐operative management (antibiotics, NSAIDs, bandaging, drain placement, immobilization, and confinement) cannot be overstated in preventing wound and incisional suture complications [3].
Suture‐related complications include dehiscence, infection without dehiscence, tissue reaction, suture ligation slippage, and suture cut‐out. When specific to the alimentary, urogenital, respiratory, musculoskeletal, and ophthalmologic systems, these complications will be discussed in detail in the respective chapters. Suture cut‐out as a complication without incisional dehiscence can occur as a separate complication in the realm of tendon repairs and certain upper airway procedures which are discussed in their respective chapters.
List of Complications Associated with Sutures
Dehiscence
Infection without dehiscence
Suture reactions
Ligature loop failure
Dehiscence
Definition
Wound or incisional dehiscence can be defined as separation of a previously apposed wound or incision. Dehiscence may be superficial or deep and partial or complete.
Risk factors
Infection
Suture placement
Poor knotting technique
Inappropriate suture material
Premature suture removal
Improper suture needle selection
Inadequate suture line tension
Excessive suture line tension
Dead space
Suturing of nonviable tissue
Inappropriate support and immobilization of a suture line
Pathogenesis
Infection
All sutures produce a local tissue reaction to some degree, which increases the susceptibility to development of an incisional infection [4]. Infection can be the primary reason causing dehiscence or can be a sequelae to dehiscence [5]. Bacteria release proteolytic enzymes that inhibit wound healing, therefore inducing wound disruption and dehiscence [5].
Tissue integrity and perfusion, local wound repair responses, and bacterial challenge, influence the presence of an infection of the suture line [6].
Degree of bacterial contamination is a useful predictor of incisional/wound infection potential [7].
Improper wound cleansing with cytotoxic substances or overzealous scrubbing can result in unnecessary tissue inflammation, edema, and necrosis, all leading to an increased risk of incisional infection and dehiscence [8].
Inadequate or traumatic debridement of necrotic, devitalized, heavily contaminated tissue and organic debris increases risk of incisional infection and dehiscence.
Use of a larger suture size than necessary results in unnecessary foreign material present within the wound/incision,
