Throughout veterinary school, we have always been taught what situations we may encounter and how specifically to handle any problems that may pop up. However, life and veterinary medicine don’t follow set rules and you may have to do something different than you thought you were going to do.
The other day I performed a displaced abomasum surgery on a cow and the case was anything but typical. First off, the cow was as fat as could be. When cutting through her flank, the different muscular layers were huge, but her internal abdominal layer was barely there. When it came time to close her incision, the teachers wanted us to close the internal and external abdominal obliques separately, so that was what I tried. After starting my simple continuous, and trying to extend it, there was no possible way that the two sides of it were going to come together. Instead, the sutures just tore out. My instructor had me try to pass through the tissue 6 times and then try to tie off the first knot, with the idea being that there would be less force on each line making it easier to pull the tissues together and hold everything together. After tying it off, I got to watch the sutures rip out of the musculature yet again.
Once the clinicians checked the situation, they decided that I would have to close both layers together while attaching them to the layer beneath. In a dog or a cat that would be easy, but considering that they were over 2 inches thick together and there wasn’t much room to see what I was doing, it was much harder than I expected. The suture needle was barely able to get through and I had to readjust my grip to fully drive it through the tissues. On one side of the incision, the internal abdominal oblique wasn’t visible so I only had to find and include it on one side. The needle holders that I had were old and didn’t grip all that well, so they kept slipping as I tried to advance the needle. By this point, I was very frustrated, but I stuck with it. After getting the first knot tied the tissues came together and things became much easier.
Now all I had to do was finish the continuous pattern. Things came along nicely, as the tissues were already close because of the sutures that were previously placed. Because we were going through a thicker layer of tissue, I had to start another simple continuous half way through and make sure to tighten everything before tying each suture. After finishing the surgery and going through so much thick muscle, my needle was bent into a W shape. While this aspect of the surgery was unexpected, I definitely learned a lot and am much more confident in my suturing abilities.