Stitches require a general?

[Cinnamontoast]

Took Goose to the vet on Thursday due to a short laceration. It probably needs 3-4 stitches having seen plenty of similar injuries over the years. The vet gave it a thorough clean, during which Goose was immobile (he’s very scared of being at the vet, despite nothing ever having happened to him bar a check up/vaccs). The vet is insisting on a general as this is apparently what they always do for stitching so the animal doesn’t move. Imo, this is a bit much. I’ve never heard of a general for stitches, except when Brig had multiple capsules full of infection along his back. It’s below his hock and quite superficial. If by a miracle it closes up by Monday-it’s vertical-it won’t need stitches.

I feel like a pita, but I don’t think it’s in his best interest to be under for such a minor procedure? Is it for the vet’s safety/avoiding needle stick injuries? I’m debating swapping back to the big practice, because of this and multiple other reasons. I’m tempted to register him at the big place on Monday and see what they say.

 

[skinnydipper]

The vet gave it a thorough clean, during which Goose was immobile (he’s very scared of being at the vet,

It will probably be less traumatic for him to have a short anaesthetic than it is for him to undergo a procedure during which he will be frozen with fear.

He won't remember the procedure if he has an anesthetic.

 

[paisley]

Would steri strips and a bandage do it? Mine didn’t have a general for a shoulder wound but it was Sunday evening and was done pretty soon after the event (shoving past me to chase something in the garden and falling into gravel), so it was less trauma to do immediately.

 

[pistolpete]

Small animal vets always anaesthetise. It’s routine. Only eat round it would be if wound was stapled closed. That is sometimes done conscious.

 

[skinnydipper]

The other thing is, will they have to debride the wound as it wasn't sutured or stapled when the wound was fresh, there is not much skin to spare below the hock to start with.

 

[rabatsa]

I had this with the greyhound at Easter. He had a skin tear and needed 2/3 stitches. I took him in straight away so a clean fresh wound, he was muzzled and standing still for all proding and the young vet still insisted he was out cold.

Next time I will treat at home with steri strips and super glue

 

[oldandgold]

Years ago dad's springer sliced her pad and needed stitches - she was a very chilled dog at the vets though and they were able to do it by numbing the area. In some cases I can understand why they would want a general though. Hope everything goes well for Goose

 

[MurphysMinder]

The other thing is, will they have to debride the wound as it wasn't sutured or stapled when the wound was fresh, there is not much skin to spare below the hock to start with.

This. Isn't it nearly a week since the injury, so it will probably need quite a bit of tidying up. Not a pleasant experience for the poor lad if he was awake.

 

[Sandstone1]

Its always a GA for stitches.

 

[Patterdale]

Operators choice. Suturing is tricky and it’s much easier to do a good job on a patient who is still and relaxed.

 

[Cinnamontoast]

This. Isn't it nearly a week since the injury, so it will probably need quite a bit of tidying up. Not a pleasant experience for the poor lad if he was awake.

Yes, we probably should have stuck him in his crate, he’s been allowed to walk round the garden (wound has been covered). I would have thought it would have been ok to do a local anaesthetic, I am in no way suggesting the vet do it without at least a local!

It will need debriding, would have done anyway, I imagine. I asked about staples but it’s a bit near the hock.

 

[poiuytrewq]

We have had one stitched with and one without. Never really thought about it until reading this. The first was my old Collie, She somehow hurt her tummy and was kept in for the night and has GA to clean and stitch.
The other, Mr P took and brought back home again an hour later stitched and bandaged, it was a very small clean wound but he must have been done without, sedated maybe, I must ask when he gets home if he remembers! It was a few years ago now.

 

[Cinnamontoast]

I’ll let you all know how he gets on. Currently asleep on my knee, as per.

 

[Clodagh]

Does it really need stitching? If you’ve got antibiotics tape it up and see?

 

[Boulty]

Yes it is partly for safety reasons as if the animal moves & panics mid stitch if conscious then yep there is the risk of vet stabbing self with needle. Also if the procedure is being done in a sterile manner (as most surgical procedures are) if the dog moves and the vet breaks sterility that’s a new pair of gloves and maybe a new kit needed.

If a contaminated wound it will need thoroughly cleaning and flushing out before stitching as if you seal debris in then wound will break down. This can take a good 5-10 minutes plus if done properly on a small wound.

If an old wound it will also need debriding (old / dead tissue cutting away to give fresh edges). Again another few minutes

Lower limbs can be a PITA to stitch as not much spare skin so different techniques may be required to avoid the surgical wound being under too much tension & breaking down. This may make it take longer.

It’s asking a lot of a conscious dog to lie (because he will have to be laid down) perfectly & completely still without so much as attempting to struggle to get up in any way (& most animals DO make occasional attempts to get up if they have to be restrained on their side and the thing they move the most is their legs which is where you’re trying to stitch in this case) for the length of time the full procedure from start to finish will take which is also creating an unpleasant experience for an animal that is already scared.

Stitching wounds conscious is not common practice in small animals (to the point I’ve never heard of it being done) although some vets will be happy to put one or two staples in a very small, very fresh superficial wound on a genuinely well behaved (not just sitting still cos terrified) animal and some vets will do minor stitch ups under deep sedation plus or minus a bit of local (with the understanding that will convert to GA if animal won’t stay still / is reacting under sedation)

 

[Cinnamontoast]

Does it really need stitching? If you’ve got antibiotics tape it up and see?

That’s what the vet said. She’s hoping it’ll seal up, but I’m not optimistic given it’s been a few days!

Yes it is partly for safety reasons as if the animal moves & panics mid stitch if conscious then yep there is the risk of vet stabbing self with needle. Also if the procedure is being done in a sterile manner (as most surgical procedures are) if the dog moves and the vet breaks sterility that’s a new pair of gloves and maybe a new kit needed.

If a contaminated wound it will need thoroughly cleaning and flushing out before stitching as if you seal debris in then wound will break down. This can take a good 5-10 minutes plus if done properly on a small wound.

If an old wound it will also need debriding (old / dead tissue cutting away to give fresh edges). Again another few minutes

Lower limbs can be a PITA to stitch as not much spare skin so different techniques may be required to avoid the surgical wound being under too much tension & breaking down. This may make it take longer.

It’s asking a lot of a conscious dog to lie (because he will have to be laid down) perfectly & completely still without so much as attempting to struggle to get up in any way (& most animals DO make occasional attempts to get up if they have to be restrained on their side and the thing they move the most is their legs which is where you’re trying to stitch in this case) for the length of time the full procedure from start to finish will take which is also creating an unpleasant experience for an animal that is already scared.

Stitching wounds conscious is not common practice in small animals (to the point I’ve never heard of it being done) although some vets will be happy to put one or two staples in a very small, very fresh superficial wound on a genuinely well behaved (not just sitting still cos terrified) animal and some vets will do minor stitch ups under deep sedation plus or minus a bit of local (with the understanding that will convert to GA if animal won’t stay still / is reacting under sedation)

Thank you for your explanation and for not assuming that I want it done with him being able to feel it! Honestly, I’d have it done for him if I could. I’m even more precious about him than any previous dog, maybe because he’s such a snuggly lad and very little!

 

[poiuytrewq]

How long do they give between incident and stitching??

 

[SusieT]

Your dog is immobile because he is terrified. Sutures are sore . He cannot consent to that pain like a human can. The vet is acting in your dogs best interest . Why do you think the vet would put your dog at risk if it was un necessary by recommending proper treatment of the wound?

 

[Boulty]

Awww bless him, fingers crossed it does decide to heal itself without intervention (a lot of the superficial ones do tbf, can just take a bit of time)

 

[planete]

We were offered sedation with local anaesthesia for a wound on our greyhound's lower leg after asking whether it could be done this way. In the end it healed well with manuka honey (Medihoney) followed by Flamazine and Melolin dressings. The hair is now growing back. The operation would have cost three hundred pounds.

Edited: it did take three weeks to heal completely. Stitches would have been much quicker. On the plus side I am now expert at bandaging dogs' legs!

 

[Aru]

Stitches just aren't something I'd attempt without Ga. It's pretty invasive and painful to do a stitch up/wound repair to a dog properly.

A week old injury will need the area cleaned, shaved and sterilised, then the tissues reopened and freshened up (ie tissue cut and removed down to the healthy bloody supply) potentially on more then one level depending on how deep the wound is,then sutures placed to bring the edges together.
If the area is under high tension like the bottom of the legs or an area of high motion, then the skin around the wound may also need to be undermined from the subcutaneous tissue- undermining means sticking a scissors under the skin then separating the layers. That loosens a larger area of tissue to then be then pulled inwards to a better apposition of skin on skin and give the best chance of successful wound closure.
Even shaving the wound edges to remove all the hair is usually pretty uncomfortable to watch...

It's usually a lot more invasive then the wound closures I've seen done in humans which just seem to be place a block, clean, flush, and bring together with the suture. bandage if needed. They rarely seem to ever actually remove tissue on the "stitch ups" I've seen. I'm not sure if it's because they are always fresh wounds or because human skin is different. Might be because we can tell humans not to move to much or they will break the sutures..and because we can reason with a human and of course explain the pain is temporary as you repeatly inject the local in a ring block..

Local anaesthetic stings, sometimes badly. Most dogs object to its use(even under sedation where I've mostly used it) and they need multiple injections of local to block a wound area properly.
Theres also a limit on how much lignocaine you can safely give to a dog.
A dog sedated deeply enough to do a wound repair and not object... are also not able to tell you if the local has worked or not.
Relevent as most sedation drugs doesn't provide pain relief, they sedate not anesthetise. The dog still feel the local placement etc, they just cannot object to it being done to them. Long sedations also are not very safe as you don't have a controlled airway etc

It's is possible to place staples in a fresh wound, though painful for the dog.
If I can staple something it's usually also an option to leave it open to heal.
If it needs stitches it's usually deep enough to need to be shaved, have deep decontamination,flushing and debridement and a proper repair... and that's an anaesthetic required situation.

I don't think I've ever even attempted a stitches level laceration without ga...it's just not the done thing to do to a dog these days. Not when anaesthetics are so safe in dogs. A short anaesthetic is usually safer then a deep sedation in most dogs.

Sorry long ramble. But hopefully helps explain some of the why behind a ga for a dog needing stitches.

 

[AlinFaolan]

One of ours sliced her chest open on a nail, think breast bone area, she was stitched up with just sedation, rural vet if it makes any difference..

 

[druid]

Stitches just aren't something I'd attempt without Ga. It's pretty invasive and painful to do a stitch up/wound repair to a dog properly.

A week old injury will need the area cleaned, shaved and sterilised, then the tissues reopened and freshened up (ie tissue cut and removed down to the healthy bloody supply) potentially on more then one level depending on how deep the wound is,then sutures placed to bring the edges together.
If the area is under high tension like the bottom of the legs or an area of high motion, then the skin around the wound may also need to be undermined from the subcutaneous tissue- undermining means sticking a scissors under the skin then separating the layers. That loosens a larger area of tissue to then be then pulled inwards to a better apposition of skin on skin and give the best chance of successful wound closure.
Even shaving the wound edges to remove all the hair is usually pretty uncomfortable to watch...

It's usually a lot more invasive then the wound closures I've seen done in humans which just seem to be place a block, clean, flush, and bring together with the suture. bandage if needed. They rarely seem to ever actually remove tissue on the "stitch ups" I've seen. I'm not sure if it's because they are always fresh wounds or because human skin is different. Might be because we can tell humans not to move to much or they will break the sutures..and because we can reason with a human and of course explain the pain is temporary as you repeatly inject the local in a ring block..

Local anaesthetic stings, sometimes badly. Most dogs object to its use(even under sedation where I've mostly used it) and they need multiple injections of local to block a wound area properly.
Theres also a limit on how much lignocaine you can safely give to a dog.
A dog sedated deeply enough to do a wound repair and not object... are also not able to tell you if the local has worked or not.
Relevent as most sedation drugs doesn't provide pain relief, they sedate not anesthetise. The dog still feel the local placement etc, they just cannot object to it being done to them. Long sedations also are not very safe as you don't have a controlled airway etc

It's is possible to place staples in a fresh wound, though painful for the dog.
If I can staple something it's usually also an option to leave it open to heal.
If it needs stitches it's usually deep enough to need to be shaved, have deep decontamination,flushing and debridement and a proper repair... and that's an anaesthetic required situation.

I don't think I've ever even attempted a stitches level laceration without ga...it's just not the done thing to do to a dog these days. Not when anaesthetics are so safe in dogs. A short anaesthetic is usually safer then a deep sedation in most dogs.

Sorry long ramble. But hopefully helps explain some of the why behind a ga for a dog needing stitches.

Well put, Aru.

 

[Cinnamontoast]

Your dog is immobile because he is terrified. Sutures are sore . He cannot consent to that pain like a human can. The vet is acting in your dogs best interest . Why do you think the vet would put your dog at risk if it was un necessary by recommending proper treatment of the wound?

Genuinely getting thoroughly peed off at the suggestions that I would expect him to have stitches without sedation (Bear had light sedation when he needed a dew claw trimmed back, obviously lots of painkiller, I assume a local). Do you honestly think I’d allow that? Obviously I’m an effing monster.

Awww bless him, fingers crossed it does decide to heal itself without intervention (a lot of the superficial ones do tbf, can just take a bit of time)

It hasn’t closed

Stitches just aren't something I'd attempt without Ga. It's pretty invasive and painful to do a stitch up/wound repair to a dog properly.

A week old injury will need the area cleaned, shaved and sterilised, then the tissues reopened and freshened up (ie tissue cut and removed down to the healthy bloody supply) potentially on more then one level depending on how deep the wound is,then sutures placed to bring the edges together.
If the area is under high tension like the bottom of the legs or an area of high motion, then the skin around the wound may also need to be undermined from the subcutaneous tissue- undermining means sticking a scissors under the skin then separating the layers. That loosens a larger area of tissue to then be then pulled inwards to a better apposition of skin on skin and give the best chance of successful wound closure.
Even shaving the wound edges to remove all the hair is usually pretty uncomfortable to watch...

It's usually a lot more invasive then the wound closures I've seen done in humans which just seem to be place a block, clean, flush, and bring together with the suture. bandage if needed. They rarely seem to ever actually remove tissue on the "stitch ups" I've seen. I'm not sure if it's because they are always fresh wounds or because human skin is different. Might be because we can tell humans not to move to much or they will break the sutures..and because we can reason with a human and of course explain the pain is temporary as you repeatly inject the local in a ring block..

Local anaesthetic stings, sometimes badly. Most dogs object to its use(even under sedation where I've mostly used it) and they need multiple injections of local to block a wound area properly.
Theres also a limit on how much lignocaine you can safely give to a dog.
A dog sedated deeply enough to do a wound repair and not object... are also not able to tell you if the local has worked or not.
Relevent as most sedation drugs doesn't provide pain relief, they sedate not anesthetise. The dog still feel the local placement etc, they just cannot object to it being done to them. Long sedations also are not very safe as you don't have a controlled airway etc

It's is possible to place staples in a fresh wound, though painful for the dog.
If I can staple something it's usually also an option to leave it open to heal.
If it needs stitches it's usually deep enough to need to be shaved, have deep decontamination,flushing and debridement and a proper repair... and that's an anaesthetic required situation.

I don't think I've ever even attempted a stitches level laceration without ga...it's just not the done thing to do to a dog these days. Not when anaesthetics are so safe in dogs. A short anaesthetic is usually safer then a deep sedation in most dogs.

Sorry long ramble. But hopefully helps explain some of the why behind a ga for a dog needing stitches.

Thank you for taking the time to explain all of that, I really appreciate it. Bar Brig’s major tissue removal, I’ve never had a dog put under for stitches, so I was surprised that the vet said it, but your explanation and that of Boulty have explained really well.

To the posters suggesting that I wanted Goose to be stitched without even a local, what the hell? Utterly ridiculous and I have no idea why you thought that. At no point did I suggest that and never would. Stupid thing to suggest.

 

[skinnydipper]

To the posters suggesting that I wanted Goose to be stitched without even a local

Did somebody say that?

You asked if stitches required a general. People replied.

 

[Aru]

I have to explain why to people all the time. Its not unusual to be asked why a ga, not a sedation and local. It's different to humans and it makes more sense when explained properly.

Same with small lumps it's amazing what the human gps and drs will take off with local alone. But it's often to much to ask of most dogs to tolerate the tissue removals awake. Especially when many canine skin masses are often deeper then the superficial layer on the skin and can have an individual blood supply.

We mostly only use sedation it to do quick and easy procedures like a torn nail etc or non invasive procedure like x-rays.

The toxicity level and amount of lignocaine that can be safely given in dogs and cats I suspect is also pretty relevent. Smaller animals =higher risk of hitting toxic doses if you need to use a larger volume to block. We need to even careful with dental blocks in the little ones...human have the advantage if being much bigger.

Sedation and local used to be more common and it is still occasionally used....but mostly it was used in the times before gas anesthetic and monitoring became the norm and g.a's in dogs became a lot safer... or when there wasn't someone there to monitor for the Vet..
Injectable anaesthetics can be ...more challenging with a higher risk profile depending on the medications used so sedations used to be preferred.

It's like anything...things tend to change as medicine advances.

I don't think anyone expects a dog to tolerate being stitched up completely awake, aware and feeling it all.

 

[Cinnamontoast]

I have to explain why to people all the time. Its not unusual to be asked why a ga, not a sedation and local. It's different to humans and it makes more sense when explained properly.

Same with small lumps it's amazing what the human gps and drs will take off with local alone. But it's often to much to ask of most dogs to tolerate the tissue removals awake. Especially when many canine skin masses are often deeper then the superficial layer on the skin and can have an individual blood supply.

We mostly only use sedation it to do quick and easy procedures like a torn nail etc or non invasive procedure like x-rays.

The toxicity level and amount of lignocaine that can be safely given in dogs and cats I suspect is also pretty relevent. Smaller animals =higher risk of hitting toxic doses if you need to use a larger volume to block. We need to even careful with dental blocks in the little ones...human have the advantage if being much bigger.

Sedation and local used to be more common and it is still occasionally used....but mostly it was used in the times before gas anesthetic and monitoring became the norm and g.a's in dogs became a lot safer... or when there wasn't someone there to monitor for the Vet..
Injectable anaesthetics can be ...more challenging with a higher risk profile depending on the medications used so sedations used to be preferred.

It's like anything...things tend to change as medicine advances.

I don't think anyone expects a dog to tolerate being stitched up completely awake, aware and feeling it all.

Thanks for more explanation. It’s the first time I’ve been told there’ll be a GA. 20 odd years of owning this breed, with various injuries and the guy who used to own the practice never used a ga, but as you say, time moves on. Thank you for your time explaining, it has made the reasons much clearer.

 

[Cinnamontoast]

Just to say, the vet says the wound is 'healing nicely' so she has re-dressed it and sent him home. I am extremely relieved! Thanks to those who have taken so much time to write really clear explanations.

 

[oldandgold]

Glad to read this - give him an ear rub from me (soft spot for Springers)