Random Surgeon Tips #2

Posted: Sep 28, 2012
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Last week during surgery I commented that pre-placing interrupted mattress sutures around opposing ribs allows for excellent apposition while maintaining just the right amount of tension along the length of the ribs. However, it also uses a bunch of suture.

There is no way around it; pre-placing sutures (i.e. placing the suture through tissues, in this case around ribs, but leaving both ends long enough to clamp and tie AFTER the remainder have been placed in similar fashion) will always result in poor suture economy. I noted to the assisting extern that I would not win any suture economy awards on this surgery. They responded that during a recent externship at an animal shelter, they was told “you are killing puppies and kittens” when you waste suture. If I hadn’t already been staring into an enormous thoracotomy incision, I would have described my reaction as “seeing red.” As it was, I bit my tongue, counted to 7 and said I thought that was a terrible message to use on anyone in our profession.

Come on people! Berating some 4th year vet student who is building his/her surgical confidence by blaming the death of other animals on his/her suture economy? Absurd. I think the animal on the table should be the focus for that person fresh to our profession. How about giving him/her some constructive feedback on knot security and tissue handling? Maybe an “oh by the way, as you get better you will waste less suture” can be squeezed into that lecture. Sure a conversation about the economics of shelter medicine (or any practice for that matter) is absolutely appropriate… sometimes. I do not think that telling externs they are “killing puppies and kittens” with their neophyte techniques is ever befitting our profession.