Ahem. Yes, size matters. Predictably, surgeons who like to make long incisions in the surgical theater think it’s a better measure of their thoroughness. Meanwhile, surgeons preferring short ones believe their way is less painful and less fraught with incision-site complications.
To my, mind, it’s a general question of style, neither one better than the other, both of which have their place in the OR. After all, we wouldn’t want our young shelter pets flayed from sternum to pubis for a routine sterilization procedure, but neither would I want my liver cancer patient handled through a button-hole. There are indications and contraindications to both.
It’s true, however, that small incision surgeons are chest-thumping egomaniacs often overly-pleased with their prowess with a scalpel. But, then, that’s true of all those who call themselves “surgeons.” Long incision surgeons may be perhaps a tad less arrogant yet they also take a superior position on their approach, defending their meticulous search and rescue approach over their colleagues’ hunt and kill.
Hmmm…methinks they all have small sports car syndrome. But I digress…
As a medium-small cut kind of girl, it seems to me I’d almost always want a smaller incision—less pain, less scarring, less of a chance I might lick my wound open, too.
Though I’ll make a huge slash when I’m in a pinch and I’ve really gotta see what’s in there—fast!—I’d much rather make a small jab and keep inching it open as my needs dictate. But, then, I’m not normally taking out ginormous spleens and searching for cancer. Those cases go to the real “surgeons.”
Long-slice surgeons like to say that both long and short incisions heal at the same rate: “they heal side to side not end to end.” Yet that’s not always been my experience—especially with really flexible dogs who’ve found every way out of my favorite e-collar and onesie combo. Long incisions=more licking. Licking=slower healing.
Still, as far as I’m concerned it’s the surgeons who can hash out the size thing amongst themselves. As long as they keep taking my cases and sending them back perfectly sewn up with no complications I guess it shouldn’t matter that much to me.
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My only experience with incision size making any difference was when my cat Target had a lumpy thing taken off his shoulder - and the only difference was for ME, not the kitty!
The incision turned out to be much longer than I expected (the lumpy thing was bigger than we all realized) and I almost cried when I saw it.
Fortunately, my vet didn't have to deal with my reaction - my boyfriend got to handle that when I arrived home as he'd been the one to pick up the cat from the vet.
The incision healed absolutely perfectly. I was a disaster pretty much until his hair grew back.
Cindy February 27th, 2008 07:10:00 PM
I'd tend to agree that smaller would be better, simply as a matter of "if it ain't broke, don't cut it" all things being equal. But when are all things equal? Hardly ever.
My question on overly large cuts would be, what about the damage to underlying tissues, connective, muscle, etc. Not on the small chance of a nick, but on the structures that aren't pushed out of the way.
I never noticed any problems with muscle healing in my arm that was sliced up good (one short deep cut, one shallow long cut) but I hear from relatives who have had abdominal surgery (large scar right up the center for an ovarian cyst and another relative with a large angular cut along the ribs for a gal bladder), that all cuts are not equal.
Is a cut over thick muscle (say the thigh) significantly different than a cut into the belly? My guess would be yes, given that the belly has only a thin layer of muscle and the bowel is a sensitive and ever changing area.
And given that all the little girls going in to have their spays done get the deluxe "into the cavity" treatment... how does a cut there compare to elsewhere?
Border Wars - Christopher February 27th, 2008 07:58:00 PM
Ella was spayed today. Her incision looks like my vet only cut her as much as she needed to.
This isn't uncommon practice for my vet as she too only cuts a animal open as far as she needs to so she can see what she's doing. When she does have to get really invasive, she feels bad about it even with post surgery meds on board.
Stacy February 27th, 2008 09:11:00 PM
What do you think of laser surgery? We have a local vet who gives it the hard sell for spay surgeries and is very definately a llllooooonnnnnnggggg cut kind of surgeon. Supposedly these are cleaner cuts and heal faster.... and, well, while I'm not a vet I see a lot of recently spayed girls in my obedience classes and based my purely anecdotal experience the long laser cuts take a lot more time to heal than the short cut standard spays I see from a couple of other local vets.
SmartDogs February 27th, 2008 09:20:00 PM
My goat's c-section ended up being longer than the vet intended at first-she had to cut more to find the danged hiding uterus. And she used a buttonhole stitch to close the skin!?
But hearing the vet mid-surgery saying "Breathe! Breathe!" and thumping ribs with her elbow was the my heart stopper. But everything ended up mostly okay.
redheather February 28th, 2008 09:41:00 AM
SmartDogs: Ahhh, the laser. In the right hands it's a wonderful tool for decreasing the inflammation and pain of procedures like declaws. In the wrong hands it can be a *disaster.* I've seen pads burnt beyond recognition as proof of its potential for harm when those without experience buy a CO2 laser thinking they don't need to learn how to wield them. I also hear boarded surgeons complain of their overuse in situations where a sharp scalpel does beter work. They tend to think it's used as a marketing gimmick by a lot of practitioners. I don't have one but would love to have another cool tool to use--judiciously I would hope.
Dr. Patty Khuly February 28th, 2008 10:52:00 AM
Christopher: For sure there are some really painful spots. Cutting through muscle means lots more pain, usually. That's why we like to go ventrally *between* the abdominal muscles--not through them.
Dr. Patty Khuly February 28th, 2008 10:54:00 AM
"chest-thumping egomaniacs often overly-pleased with their prowess with a scalpel"
Were you talking about me?
Marc February 28th, 2008 11:21:00 AM
What about scar tissue? It would seem that longer insisions would tend to have more scar tissue which could cause problems.
Diana Krause February 28th, 2008 12:50:00 PM
Marc: If the shoe fits...
Dr. Patty Khuly February 28th, 2008 03:24:00 PM
Hmmm, with my own dogs, I've seen the "long and short" ! I was told with one girl, her incision was longer than most because of excessive bleeding----
One had a C-section, so small was the incision, I have no idea how that huge uterus came out (I was there). Another with a C-section from chest to vulva (well almost!)
And a weird looking laser cut spay on my last girl, that healed beautifully & quickly!
Barbara A. Albright February 28th, 2008 09:08:00 PM
I know a vet who does pediatric altering of kittens. I'm absolutely amazed by how small his incisions are. often no bigger than a pencil. Great for the kittens, and the new owners, but I am often left wondering what happens when these kittens grow up and escape and end up back in the shelter environment. the staff will look for spay scars and not find them... :(
Connie March 3rd, 2008 03:20:00 PM
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