Surgery of Exotic Animals. Группа авторов

rolling action between the thumb and fingers. Even with scissors and forceps, it is easier to roll them if the handles are round. Many surgeons prefer needle holders without box lock for delicate tissue because when the lock is set, the needle can jump and tear tissues. Hold a microsurgical instrument as if you were holding a pen (Figure 1.8a). An across‐the‐palm grip is inappropriate (Figure 1.8b). As a starting point, a microsurgical pack should contain a microsurgical needle holder, a microsurgical scissors, and microsurgical thumb forceps (Figure 1.9). Add other microsurgical instruments to the pack with increasing experience.

Figure 1.5 An Alm retractor (a) uses a thumb screw to open the jaws, while the Heiss retractor (b) has a quick release ratchet mechanism.

Figure 1.6 The Lone Star retractor system consists of a plastic ring with notches around the perimeter (a) and silastic bands with tissue hooks that are placed in the tissue to be retracted (b). Insert the bands into the notches in the ring to maintain tissue retraction.

Figure 1.7 Microsurgical instruments should be a standard length with miniaturized tips that extend beyond the hand into the tissue and should be counterbalanced to minimize hand fatigue.

      Suction and Irrigation

Ophthalmic bulb syringes work well for tissue irrigation in small exotic animals (Figure 1.10). Alternatively, use a syringe with a needle attached and bend the needle at the hub repeatedly until it breaks off to minimize the risk damaging tissue with the needle. Fine Barron suction tips have a release hole providing two degrees of suction; stronger suction with the hole covered and more delicate suction with the hole open. If tissues suck up against the tip, place the corner 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.

      5 Hughes, K., Chang, Y.C., Sedrak, J., and Torres, A. (2007). A clinically practical way to estimate surgical blood loss. Dermatology Online Journal 13 (4): 17.

      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.

      8 Redrobe, S. (2002). Soft tissue surgery of rabbits and rodents. Seminars in Avian and Exotic Pet Medicine 11: 231–245.

      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