OBJECTIVE To determine the effect of repeated gas sterilization on rate of closure of ameroid ring constrictors in vitro.
SAMPLE Twenty-four 3.5-mm ameroid ring constrictors.
PROCEDURES Ameroid ring constrictors were allocated to 1 of 4 treatment groups (6/group) to undergo gas sterilization 0, 1, 5, or 10 times. After sterilization, constrictors were incubated in canine plasma at a protein concentration of 3 g/dL for 27 days. A digital camera was used to obtain images of the constrictors prior to and at various points during incubation, and lumen diameter was measured.
RESULTS Mean ± SD percentage of lumen closure for all groups of ameroid ring constrictors combined was 85.2 ± 1.6% at day 0 (prior to plasma incubation) and 95.4 ± 0.8% at day 27. Mean lumen area was 3.64 ± 0.43 mm2 (95% confidence interval, 2.67 to 4.77 mm2) at day 0 and 1.32 ± 0.25 mm2 (95% confidence interval, 0.76 to 2.04 mm2) at day 27. None of the ameroid ring constrictors had closed completely by day 27.
CONCLUSIONS AND CLINICAL RELEVANCE Overall closure rates for ameroid ring constrictors appeared to be unaffected by repeated gas sterilization up to 10 times. Findings suggested that veterinary surgeons can resterilize ameroid ring constrictors up to 10 times with confidence that ring properties would remain suitable for clinical use.
OBJECTIVE To compare intraluminal pressure at initial leakage (leakage pressure), leakage location, and maximum intraluminal pressure (MIP) for various staple line offset configurations of functional end-to-end stapled anastomosis (FEESA).
SAMPLE Grossly normal jejunal segments from 4 canine cadavers.
PROCEDURES 52 jejunal segments (4 control and 24 anastomosis constructs [2 segments/standard FEESA construct]) were prepared for testing. Segments were assigned to three 8-segment gastrointestinal anastomosis staple line offset groups: complete offset (CSO group), partial gastrointestinal anastomosis offset (PSO group), and no gastrointestinal anastomosis offset (NSO group). Results for leakage pressure, leakage location, and MIP were compared.
RESULTS Mean ± SD leakage pressure differed significantly among all groups and was highest for the PSO group (34.4 ± 3.7 mm Hg), followed by the CSO group (25.9 ± 4.1 mm Hg) and the NSO group (18.8 ± 1.5 mm Hg). Leakage location did not differ significantly among groups but was most commonly associated with the thoracoabdominal staple line. The MIP did not differ significantly among groups (PSO, 83.1 ± 9.4 mm Hg; CSO, 81.7 ± 6.7 mm Hg; and NSO, 58.5 ± 7.7 mm Hg).
CONCLUSIONS AND CLINICAL RELEVANCE In this study, partial staple line offset leaked at a significantly higher pressure, which represented the greatest leakage protection of tested constructs. The thoracoabdominal staple line was more susceptible to leakage than was the gastrointestinal anastomosis staple line. Results suggested that surgeons should avoid FEESA with no staple line offset, strive for partial offset of the gastrointestinal anastomosis staples, and provide precise placement of the thoracoabdominal staple line.
OBJECTIVE To compare pursestring, Witzel (seromuscular inversion), and seromuscular incision jejunostomy tube placement techniques in vitro.
SAMPLE Jejunal specimens from 10 dogs.
PROCEDURES Jejunal segments (50 cm) were harvested immediately prior to euthanasia from 10 mixed-breed dogs Specimens were harvested with the orad and aborad ends clamped and stored in saline (0.9% NaCl) solution–soaked towels during instrumentation. Three jejunostomy tubes were placed via 3 techniques (pursestring, Witzel, and seromuscular incision), and 2 double lumen central venous catheters were placed at each intestinal end for luminal filling and leak testing. Intestinal luminal area was measured ultrasonographically with specimens suspended in a warm undyed saline solution bath with the intestinal lumen filled with dyed saline solution (intraluminal pressure, 6 mm Hg). Leak testing was performed by means of infusion of dyed saline solution (4 mL/min) until each jejunostomy site failed. Intestinal luminal area and leakage pressure were compared between the 3 tube placement techniques.
RESULTS The Witzel and seromuscular incision techniques decreased the intestinal luminal area measured at the tube insertion site, albeit nonsignificantly. For the seromuscular incision technique, a significant decrease in intestinal luminal area at the intraluminal site of measurement was found. For 2/30 specimens (1/10 pursestring and 1/10 seromuscular incision), failure occurred at pressures within the range of previously reported peak peristaltic pressure for dogs. Failure occurred at supraphysiologic peristaltic pressures for the remaining 28 specimens, including all 10 specimens for the Witzel technique.
CONCLUSIONS AND CLINICAL RELEVANCE In this in vitro study, all specimens for the Witzel technique withstood physiologic peristaltic pressures during leak testing. Both tunneling techniques (Witzel and seromuscular incision) created a decrease in intestinal luminal area. Further investigation, including in vivo testing, is indicated to evaluate the clinical relevance of these findings.
OBJECTIVE To compare the mechanical properties of laryngeal tie-forward (LTF) constructs prepared with different suture materials and suture placement patterns during single load to failure testing.
SAMPLE Larynges harvested from 50 horse cadavers and 5 intact horse cadavers.
PROCEDURES In vitro LTF constructs were created by a standard technique with polyester sutures, a standard technique with polyethylene sutures, a modified technique with metallic implants and polyester sutures, a modified technique with metallic implants and polyethylene sutures, or a modified tie-off technique with polyester sutures (10 of each type of construct). Mechanical properties including maximal load (N) at failure and failure mode were compared among constructs. Also, maximal loads at failure of the in vitro LTF constructs were compared with the loads exerted on the sutures tightened to achieve rostral laryngeal advancement in intact cadavers.
RESULTS Constructs prepared by a standard technique with polyethylene sutures had a significantly higher pull out strength than those prepared by a modified technique with metallic implants and either polyester or polyethylene sutures. For constructs prepared by a standard technique with polyethylene sutures or similarly placed polyester sutures, maximal load at failure did not differ but the failure mode did differ significantly. The load to failure for all in vitro constructs was higher than the maximal load measured during a range of motion test in intact horse cadavers.
CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that LTF procedures can be performed in live horses with any of the suture materials and techniques tested.
Objective—To assess the effects of sample size and location, skin tension lines, surgeon, and formalin fixation on the extent of shrinkage that occurs in excised canine skin samples.
Animals—Cadavers of 4 adult purpose-bred mixed-breed hound dogs with grossly normal skin.
Procedures—54 circular areas of skin (2-, 4-, and 6-cm-diameter samples from each of 9 body regions on each side) were excised by 1 of 2 surgeons from each cadaver. The diameter of each sample was measured in 4 orientations (parallel to previously reported tension lines, perpendicular to tension lines, in a dorsoventral orientation, and in a craniocaudal [or rostrocaudal] orientation) at 3 time points (before and immediately after excision and after 24 hours of formalin fixation).
Results—216 samples were measured in all 4 orientations at all 3 time points. For all samples, mean ± SE decrease in diameter after fixation, compared with pre-excision findings, was 6.2 ± 0.7 mm. No significant correlations were found between percentage of skin shrinkage and surgeon, body side or region, or measurement orientation in relation to skin tension lines. The mean sample diameter immediately after excision differed significantly from that before excision (mean diameter decrease, 5.5 ± 0.7 mm). Overall, sample diameter immediately after excision and after formalin fixation did not differ.
Conclusions and Clinical Relevance—The extent of shrinkage of skin samples from hound cadavers that occurred immediately after excision was notable. A better understanding of the effectors of excised skin sample shrinkage is needed, especially when histopathologic findings provide guidelines for surgical margins.
Objective—To evaluate the effect of multiple hydrogen peroxide gas plasma (HPGP) sterilizations on the rate of closure of ameroid constrictors.
Sample—Thirty-six 5.0-mm ameroid constrictors.
Procedures—Ameroid constrictors were randomly allocated to 6 groups. Each group underwent 1, 2, 3, 4, 5, or 6 HPGP sterilizations. Ameroid constrictors were then incubated for 35 days in canine plasma and digitally imaged at predetermined times during incubation. One individual, who was unaware of the group to which each ameroid constrictor was assigned, measured the lumen area of the constrictor on each digital image. Mean lumen area was compared among groups.
Results—No ameroid constrictors were completely closed after 35 days of incubation in canine plasma. Mean lumen area after incubation did not differ among constrictors that underwent 1, 2, and 3 sterilizations. Constrictors that underwent 4 sterilizations were closed significantly more than were those that underwent 1, 2, or 3 sterilizations. Mean lumen area after incubation did not differ significantly between constrictors that underwent 5 and 6 sterilizations, although the final lumen areas for those constrictors were significantly smaller than those for constrictors that underwent 1, 2, 3, and 4 sterilizations.
Conclusions and Clinical Relevance—Ameroid constrictors that underwent 5 and 6 HPGP sterilizations had a 9% to 12% decrease in lumen area, compared with that of constrictors that underwent ≤ 4 plasma sterilizations, and the use of such constrictors could increase the risk of portal hypertension and secondary acquired shunting or decrease the risk of persistent shunting.
Objective—To determine effects of staple size, precompression time, and tissue thickness on staple shape and tissue approximation in side-to-side jejunocecal anastomosis in equine specimens.
Sample—Cecum, ileum, and jejunum specimens obtained from 18 healthy horses at an abattoir.
Procedures—Specimens were allotted into 2 groups. Anastomoses were stapled with 4.8-or 3.8-mm staples. Precompression time was 15 seconds for both groups. Staple lines were cut into proximal, middle, and distal sections. Thickness of intestinal walls was measured with a calibrated tissue micrometer, photographs were obtained, and intestinal tissues were digested. An investigator measured staples and assessed the shape of staples on high-definition digital images. Number of optimally shaped staples and staple height were compared among sections and between groups.
Results—Use of 4.8-mm staples resulted in poor approximation of tissues in the distal sections of anastomoses. The percentage of optimally shaped staples was 538 of 551 (97.6%) and 616 of 634 (97.2%) for 4.8- and 3.8-mm staples, respectively. The percentage of optimally shaped staples did not differ significantly between groups for the same sections. There was a lower percentage of optimally shaped staples in the distal sections than in the proximal and middle sections of each group. Mean staple height did not differ significantly among sections of each group.
Conclusions and Clinical Relevance—Use of 3.8-mm staples with an adequate precompression time for jejunocecal anastomosis in horses resulted in proper staple shape. These findings could be used to improve the technique and outcome for stapled jejunocecal anastomoses in horses.
Objective—To evaluate anatomic landmarks to define the ideal suture placement location to achieve appropriate and consistent arytenoid cartilage abduction via unilateral cricoarytenoid lateralization (UCL) in dogs.
Sample—6 cadaveric canine larynges.
Procedures—Laryngeal airway resistance (LAR) was determined for each specimen before (baseline) and after suture placements with the epiglottis open and closed. To achieve UCL, suture was placed through the cricoid cartilage just caudal to the cricoarytenoid articulation (suture placement position [SPP] 1), one-fourth of the distance caudally between the cricoarytenoid and cricothyroid articulations (SPP 2), and three-fourths of the distance caudally between the cricoarytenoid and cricothyroid articulations (SPP 3). The LAR was again calculated after tensioning of each suture separately.
Results—With a closed epiglottis, median LAR was 30.0, 20.4, 11.4, and 3.3 cm H2O/L/s at baseline and SPPs 1, 2, and 3, respectively. After UCL at SPP 1, LAR with the epiglottis closed was not significantly different from that at baseline. With an open epiglottis, median LAR was 2.0, 0.4, 0.2, and 0.0 cm H2O/L/s at baseline and SPPs 1, 2, and 3, respectively. After UCL at SPPs 1, 2, or 3, LAR with an open epiglottis was significantly lower than that at baseline.
Conclusions and Clinical Relevance—Results indicated that placement of suture through the cricoid cartilage at the caudal border of the cricoarytenoid articulation was appropriate to sufficiently reduce LAR without increasing the risk of aspiration pneumonia through overabduction of the arytenoid cartilage.
Objective—To compare the mechanical properties of laryngeal tie-forward (LTF) surrogate constructs prepared with steel fixtures and No. 5 braided polyester or braided polyethylene by use of a standard or a modified suture placement technique.
Sample—32 LTF surrogate constructs.
Procedures—Surrogate constructs were prepared with steel fixtures and sutures (polyester or polyethylene) by use of a standard or modified suture placement technique. Constructs underwent single-load-to-failure testing. Maximal load at failure, elongation at failure, stiffness, and suture breakage sites were compared among constructs prepared with polyester sutures by means of the standard (n = 10) or modified (10) technique and those prepared with polyethylene sutures with the standard (6) or modified (6) technique.
Results—Polyethylene suture constructs had higher stiffness, higher load at failure, and lower elongation at failure than did polyester suture constructs. Constructs prepared with the modified technique had higher load at failure than did those prepared with the standard technique for both suture materials. All sutures broke at the knot in constructs prepared with the standard technique. Sutures broke at a location away from the knot in 13 of 16 constructs prepared with the modified technique (3 such constructs with polyethylene sutures broke at the knot).
Conclusions and Clinical Relevance—Results suggested LTF surrogate constructs prepared with polyethylene sutures or the modified technique were stronger than those prepared with polyester sutures or the standard technique.
Objective—To determine characteristics of the inflammatory reaction in the jejunum of horses in response to various mechanical manipulations.
Animals—12 adult warmblood horses without gastrointestinal tract disorders.
Procedures—The proximal aspect of the jejunum in each horse was divided into 5 segments, and the following manipulations were performed: manual emptying, placement of Doyen forceps, enterotomy alone, enterotomy with mucosal abrasion, and serosal abrasion. Jejunum samples were collected before (control), immediately after, and 30 minutes after the end of manipulations and histologically evaluated to determine distribution of neutrophils and eosinophils.
Results—Macroscopically, all manipulations resulted in jejunal hemorrhage and edema. Compared with control samples, neutrophil numbers were significantly higher after manipulations in the serosa (after all manipulation types), circular muscle layer (after manual emptying), submucosa (after placement of Doyen forceps), and mucosa (after all manipulations except enterotomy alone). Eosinophil numbers were significantly higher in the submucosa after mechanical abrasion of the serosa and manual emptying versus control samples.
Conclusions and Clinical Relevance—Results indicated mechanical manipulation of the jejunum resulted in local inflammatory reactions characterized predominantly by infiltration of neutrophils. This could contribute to the development of postoperative ileus or adhesions in horses without macroscopically detectable injury of the jejunum during surgery.