One of the best general practitioners I have ever worked with said to me…
As a vet student, most surgical training emphasises the use of the common suture patterns (simple interrupted, simple continuous, cruciate etc.) and knots (square knots and surgeons knots). So it can be a bit daunting in practice to start trialing the use of other suturing techniques – of which there are many, all with their various indications for use, and pros and cons.
Even experienced general practitioners may steer away from using new knots, especially when a tried and tested technique has likely been successful so many times in the past, and because knot failures can be disastrous. And there is certainly every argument for using the technique in which you are most experienced, unless there is a contraindication for doing so.
However, there is also an argument for continual learning and self-improvement in veterinary practice, and if you can learn about new or different techniques that can improve outcomes, even if minor, then you should try to do so. As a not insignificant side effect, one of the satisfying elements of surgery, apart from the potential for healing, are the many different fine motor skills that are involved and the increased dexterity that is developed in performing them.
The Aberdeen knot is a great example of an alternative knot that can be used at the end of continuous suture lines, as demonstrated in this video featuring specialist surgeon Dr Abbie Tipler of Veterinary Specialist Services. It’s fairly straightforward to learn, and when used to close the subcutaneous tissues, it allows the surgeon to continue directly to an intradermal closure without cutting the subcutaneous suture line . It’s easy to practice suturing and knot tying without a patient of course, and so this is a great place to start if you are looking to improve your surgical skills before you next get the chance to be hands on in a workshop.
About the Presenter
Dr Abbie Tipler is a Small Animal Surgical Registrar at Veterinary Specialist Services. She graduated from Massey University in 2005 and soon after graduation discovered her passion for Small Animal Surgery. This took her to London where she worked for several years in a combined general practice/orthopaedic referral practice. In 2010 she moved to Sydney and sat her ANZCVS Memberships in Small Animal Surgery and in 2016 was chosen as head examiner for Memberships in Surgery. She is an active member of the surgical chapter and a regular attendee at surgical conferences world-wide including ACVS, ANZCVS Science Week and BVOA. She is a member of AO VET and is a published author in several veterinary journals. Abbie has spent time seeing practice or completing externship at some of the top veterinary universities including UC Davis and Bristol University. In 2017 she founded the Small Animal Surgery Discussion Page for world-wide surgical discussion which has thousands of veterinary members. In 2018 she was the recipient of the ANZCVS travel grant for services to the Surgery Chapter. She has been actively involved in charities such as Pets in the Park, Elephants Rhinos People, Greyhound Rescue and Cantoo. She lives in Saint Lucia, Brisbane with her husband, two young children and three ragdoll cats. You can follow Abbie on Instgram @drabbietipler where she shares surgical tips for veterinarians and other veterinary related topics.
Need to know more?
There are of course many detailed descriptions of suturing techniques and knots in the various veterinary surgical texts, including the recently updated Small Animal Surgery Expert Consult by TW Fossum (2018) and in Veterinary Surgery Small Animal 2e by Tobias and Johnston (2017).
The Clinician’s Brief article (in references, below) on friction knots including the Abderdeen knot is also a helpful introduction.
References Case, J.B and Fox-Alvarez, W.A., Surgeon’s Corner: Friction Knots & the Aberdeen Knot [Website], https://www.cliniciansbrief.com/article/surgeons-corner-friction-knots-aberdeen-knot (accessed 28 June 2021)