Biomedical Engineering Reference
In-Depth Information
Ducts
Bile Duct
Primary repairs can be attempted with 4-0 to
6-0 monofilament absorbable sutures (increased risk of
leaks or stenosis) or stents.
Muscles
For repairs, synthetic absorbable on nonabsorbable mate-
rial is recommended.
Tendons
For repairs, use nylon or stainless steel. Polydioxanone,
polyglyconate can be used for the synovial capsule.
Parotid Duct
Repairs are difficult because of the size; it is
usually ligated.
Ligaments
For repairs, use polypropylene.
Ureter
Surgical manipulations are difficult because of the
size and require using magnifying devices or an operating
microscope. An ureteral stent can be used when an anas-
tomosis is performed with 5-0 synthetic absorbable suture.
Complications include dehiscence, obstruction, and stric-
ture. In human patients, a tapered segment of ileum is
commonly used to bridge or replace a ureteral defect.
Peripheral Nerves
Nylon and polypropylene (both nonreactive) recommended
for repairs.
Heart
Nylon, polypropylene, and polybutylate coated braided
polyester (valve repairs) have been used.
Hollow Organs
Stomach
Nonhuman primates may develop acute gastric
dilatation (bloat) secondary to the rapid production of gas
by clostridial organisms. Predisposing factors may include
a sudden change in diet, prolonged broad-spectrum anti-
biotic therapy, anesthesia, shipping, and fasting followed
by free-choice feeding. Bloat may be a result of
a nonhuman primate's eating habits, such as voracious
consumption of large quantities of food, combined with
physical exercise and may be seen more often in group-
housed, nondominant animals that eat irregularly. Gluten-
sensitive nonhuman primates, like humans, are more prone
to developing bloats. A word of caution to trigger-happy
surgeons
Lung
In partial lobectomy, after the amputation employ a contin-
uous, overlapping hemostatic or pneumostatic suture (3-0 or
4-0 absorbable material). The edge is oversewn with
a closely spaced simple continuous pattern (4-0 or 5-0
absorbable material). Stapling devices can also be used.
Salivary Gland
After removal, closure with monofilament absorbable.
not all bloats should be treated surgically! An
experienced clinician will distinguish between frothy bloat
that can be controlled with diet and/or antifoaming agents
(e.g. poloxalene) and acute bloat with free gas accumula-
tion which may be resolved by passing a stomach tube.
Emergent, life-threatening acute bloats should be resolved
by placing a trocar and performing exploratory laparotomy
(for closure, see the section “Tubular structures/Intestine”
above).
e
Liver
Use staples for closure of blood vessels and biliary ducts
after lobectomy. In liver biopsies use suture fracture tech-
nique (crushing liver parenchyma by tightening the suture
using nonabsorbable material). Specialized instruments
such as a Harmonic scalpel, which is similar in function to
a standard electrocautery but are capable of cutting thicker
tissues, create less smoke, and offer greater precision, can
be useful in liver manipulations.
Uterus
In hysterotomy or hysterectomy, a single or double
layer closure with 3-0 or 4-0 absorbable sutures should be
employed.
Pancreas
For closure after partial pancreatectomy, the suture fracture
technique (see the section “Liver” above) is recommended.
Gall Bladder
In cholecystotomy or cholecystectomy
a single layer closure using 4-0 monofilament absorbable
simple interrupted or continuous inverting suture pattern
(Lembert's, Cushing's) is recommended.
Spleen
Closure after partial splenectomy can be accomplished with
monofilament, absorbable material using interrupted
mattress pattern or Parker-Kerr technique.
Urinary Bladder
Fluidtight closure in cystotomy can be
accomplished by a single or double layer with 3-0 or 4-0
synthetic absorbable sutures using inverting suture pattern
of simple continuous Lembert's or Cushing's.
Kidney
Closure of nephrotomy can be done with gentle digital
apposition of renal parenchymal flaps followed by the renal
