Complications in Equine Surgery. Группа авторов

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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