With the increasing popularity of reptiles as pets over the past 20 years, there has been an increased demand for veterinary expertise in reptile medicine and surgery.1,2 The frequency of performing surgery on reptile patients has increased, and many procedures are now commonly performed.2–4 The overall process of wound healing in reptiles is similar to that in mammals but slower.2,3,5 Certain aspects of wound healing that are unique in reptiles must be taken into consideration as part of their surgical treatment. Healing in reptiles can be influenced by the environmental temperature, the wound orientation, and the nutritional and health status of the animal.2,5–7 The inflammatory cells of reptiles may also differ from those of mammals, and they may not have the same proteolytic enzymes needed to break down some suture materials.3 These factors may have a role in the selection of appropriate suture material.
Sutures are placed to maintain incised or injured tissue in apposition to allow the tissue to heal.8–10 The ideal suture material should have high tensile strength to resist fragmentation and provide sufficient time to allow tissue healing, have good knot security, resist infection, and cause no inflammatory, immunogenic, or carcinogenic reactions. The reaction of tissue to suture materials depends on several variables such as the type, quantity, and duration of suture implantation as well as characteristics of the tissues into which material is implanted.
Various studies11–18 have investigated the degree of tissue reaction to different suture materials in various species, and the tissue reaction to suture materials in reptiles has been previously investigated in a single study.13 That investigation was limited to 4 suture materials, and the histologic reaction was only evaluated at 1 time point, 7 days following surgical sex determination. Although those findings provided some insight into wound healing in reptiles, the study duration was too short to provide information regarding the long-term histologic response to common suture materials. The purpose of the study reported here was to evaluate the histologic reactions to 8 suture materials and CTA in the musculature and skin of ball pythons (Python regius) over a period of 90 days. Although there are anatomic and physiologic differences, we hypothesized that the histologic reactions to suture materials in ball pythons would be similar to those that occur in homeo-thermic vertebrates.
Cyanoacrylate tissue adhesive
Perivascular lymphocyte score
Suture fragmentation score
Ben Siegel Reptiles, Deerfield Beach, Fla.
PVC Cages, Grand Haven, Mich.
Fort Dodge Animal Health, Fort Dodge, Iowa.
Abbott Laboratories, North Chicago, Ill.
IsoFlo, Abbott Laboratories, North Chicago, Ill.
Angiocath, Becton-Dickinson, Sandy, Utah.
Large Surgical Drape, Veterinary Specialty Products, Mission, Kan.
PDS, Novartis Animal Health, Greensboro, NC.
PDS Plus, Novartis Animal Health, Greensboro, NC.
Monocryl, Novartis Animal Health, Greensboro, NC.
Monocryl Plus, Novartis Animal Health, Greensboro, NC.
Vicryl, Novartis Animal Health, Greensboro, NC.
Ethilon, Novartis Animal Health, Greensboro, NC.
Novartis Animal Health, Greensboro, NC.
Reflex One, Conmed, Utica, NY.
Vetbond, 3M, Saint Paul, Minn.
Sleepaway, Fort Dodge, Madison, NJ.
SPSS, version 16.0, SPSS Inc, Chicago, Ill.
Vicryl Rapide, Novartis Animal Health, Greensboro, NC.
Mitchell MA. History of exotic pets. In: Mitchell MA, Tully TN, eds. Manual of exotic pet practice. St Louis: Saunders, 2009;1–3.
Smith DA, Barker IK. Healing of cutaneous wounds in the common garter snake (Thamnophis sirtalis). Can J Vet Res 1988; 52: 111–119.
Smith DA, Barker IK, Allen B. The effect of ambient temperature and type of wound on healing of cutaneous wounds in the common garter snake (Thamnophis sirtalis). Can J Vet Res 1988; 52: 120–128.
Smith DA, Barker IK, Allen B. The effect of certain topical medications on healing of cutaneous wounds in the common garter snake (Thamnophis sirtalis). Can J Vet Res 1999; 52: 129–133.
Roush JK. Biomaterials and surgical implants. In: Slatter D, ed. Textbook of small animal surgery. 3rd ed. Philadelphia: Saunders, 2003;141–148.
Bellenger CR. Sutures part I: the purpose of sutures and available suture materials. Compend Contin Educ Pract Vet 1982; 4: 507–515.
van Rijssel EJC, Brand R, Admiraal C, et al. Tissue reaction and surgical knots: the effect of suture size, knot configuration, and knot volume. Obstet Gynecol 1989; 74: 64–68.
Bennett RA, Yaeger MJ, Trapp A, et al. Histologic evaluation of the tissue reaction to five suture materials in the body wall of rock doves (Columba livia). J Avian Med Surg 1997; 11: 175–182.
DeNardo GA, Brown NO, Trenka-Benthin S, et al. Comparison of seven different suture materials in the feline oral cavity. J Am Anim Hosp Assoc 1996; 32: 164–172.
Govett PD, Harms CA, Linder KE, et al. Effects of four different suture materials on the surgical wound healing of loggerhead sea turtles, Caretta caretta. J Herpetol Med Surg 2004; 14: 6–10.
Hurty CA, Brazik DC, Law JM, et al. Evaluation of the tissue reactions in the skin and body wall of koi (Cyprinus carpio) to five suture materials. Vet Rec 2002; 151: 324–328.
Tuttle AD, Law JM, Harms CA, et al. Evaluation of the gross and histologic reactions to five commonly used suture materials in the skin of the African clawed frog (Xenopus laevis). J Am Assoc Lab Anim Sci 2006; 45: 22–26.
Woods DS, Collins JE, Walshaw R. Tissue reaction to nonabsorbable suture materials in the canine linea alba: a histologic evaluation. J Am Anim Hosp Assoc 1984; 20: 39–94.
Sanz LE, Patterson JA, Kamath R, et al. Comparison of Maxon suture with Vicryl, chromic catgut, and PDS sutures in fascial closure in rats. Obstet Gynecol 1988; 71: 418–422.
Yaltririk M, Dedeoglu K, Koray M, et al. Comparison of four different suture materials in soft tissues of rats. Oral Dis 2003; 9: 284–286.
Bennett RA. Preparation and equipment useful for surgery in small exotic pets. Vet Clin North Am Exot Anim Pract 2000; 3: 563–585.
Homsy CA, McDonald KE, Akers WW. Surgical suture—canine tissue interactions for six common suture types. J Biomed Mater Res 1968; 2: 215–230.
Jacobson ER, Millichamp NJ, Gaskin JM. Use of a polyvalent autogenous bacterin for treatment of mixed gram-negative bacterial osteomyelitis in a rhinoceros viper. J Am Vet Med Assoc 1985; 187: 1224–1225.
Drake DB, Rodeheaver PF, Edlich RF, et al. Experimental studies in swine for measurement of suture extrusion. J Long Term Eff Med Implants 2004; 14: 251–259.
Conn KS, Dunning JJ, Pillai R. Extrusion of Teflon aortic pledgets from a sternal wound six years after cardiac surgery. Eur J Cardiothorac Surg 1997; 12: 150–151.