AdvancesinSuturingTechniqueandMaterials forSurgicallyImplantingTransmittersin JuvenileSalmonids Juvenile Salmonids

ChristaWoodley,KatherineDeters,KathleenCarter, Christa Woodley Katherine Deters Kathleen Carter JamesBoyd,JenniferPantherandRichardBrown

PacificNorthwestNationalLaboratory Richland,WA i hl d

And M.BradEppard
UnitedStatesArmyCorpofEngineers , , PortlandDistrict,Portland,OR
1

Background
US ACE has funded the Tag Effects study since 2006

> 60,000 juvenile salmon from Snake & Columbia implanted

Juvenile Salmon Acoustic Telemetry System (JSATS) transmitter

Minimize the effects of the acoustic tag implantation surgery on juvenile salmon
Suture type monofilaments yp
(Deters et al. -accepted)

Incision location linea alba (J. Panther) Optimal suturing technique Alternative suturing technique

Problem
Current technique and traditional sutures in general can cause:
Ulceration Inflammation Hemorrhaging &/ congestion (R d H h i &/or ti (Redness) ) Fungal growth Secondary infection good apposition Low surface area L f Has high tag retention Robust to surgeon skills Appropriate for large scale operations
3

Achieve

What should sutures do?

Keep the incision closed Cause minimal trauma Keep transmitters retained Sutures remain until the incision is healed

Goals: Traditional Approach

Suturing technique that causes the least trauma g q to the tissue and keeps the incision closed Reduce the knot profile Reduce the number of knots

Methods: Traditional & Alternative Approach

540 Juvenile Spring Chinook Salmon
JSATS acoustic transmitter and PIT tag
Combined mass 0.54 g in air Mean Tag Burden = 4 0% (2 5 5 8) 4.0% (2.5-5.8)

Mean FL 109 mm (96 117) Mean weight 16g (9.3 22.1)

3S Surgeons Water temperature 12 or 17C 17 C

Weekly Examinations and Images

Day 7 Day 28 Response Variables Suture Retention (presence/absence) Redness (measured) R d ( d) Ulceration (measured) Fungus (observed) Incision Openness (measured) Necrosis (observed)

Treatments: 5 Suturing Techniques

1x1x1x1 2x1x1x1 2x2x2x2 2x2x2x2 Two discontinuous

Horizontal Mattress (2 x 1 x 1 x 1)

Redn ness (mm2) m

0.1 0.2 0.3 0.4 0.5 0.6 0.0 00
1 x 1
12C 17C

2 x 1 2 x 2 x 2 D ou H or bl e .m at tr es s 2

Results: Redness

Day 7

1 x x 2 2 x 2 x 1 2 1

Day 14

2 D ou H or bl e .m at tr es s

10

Ulcer ration (mm2) m

0.1 0.2 0.3 0.4 0.0 00
1 x 1
12C 17C

2 x 1 2 x 2 x 2 D ou bl e ss m at tr e H or . 2

Results: Ulcerations

Day 7

1 x x 2 2 x 2 x 1 2 1

Day 14

2 D ou H or bl e .m at tr es s

(Preliminary) Conclusions: Traditional Approach

Testing and analysis is ongoing General trends
1 JSATS tag expelled (out of 540 fish) Ulceration tends to increased over time for horizontal
mattress

Redness tends to increase over time for double 2X2 Suture retention lower among 1X1 than 2X2 for less trained surgeons

11

Why do an Alternative Approach?

Traditional sutures tend to:
High Hi h profile sutures h fil t have l large surface area f attracts microbial and fungal growth Ulcerations Suture knots, tissue tearing Inflammation Hemorrhaging &/or Congestion (Redness) Poor Apposition pp Difficult to meet thin tissue layers
12

Methods:Knotlesssutures
QuillSRS Worksontensionandangleoftensiontomaintainits Works on tension and angle of tension to maintain its position Madeforcosmeticandinternalsurgery grabbingtissue Disadvantage:
30MONODERM 7cm X7cm 3/8Circle18mm DiamondPoint

13

Methods: Using full suture

Barbed Wide-N Barbed 6-point 6-point
Second Insertion External Internal Whole suture

Initial Insertion

Exit

Methods:
Barbed Wide-N with a square knot Barrier Film - 2 discontinuous sutures - 2x2x2x2 knot

Second Insertion Internal

Initial Insertion

External

16

Re edness (m 2) mm
2.5 25 0.0 0.5 1.0 1.5 2.0

6 Se co nd
12C 17C

po in t sk in

Day 7

W W id e N kn ot id e N

Results: Redness

6 Se co nd

po in t sk in W W id e id N e

Day 14

N kn ot

17

Ul lceration (mm2)
0.0 0.4 0.8 1.2 1.6 2.0 2.4 2.8

6 Se co nd
12C 17C

po in t sk in

Day 7

W W id e N kn ot id e N

Results: Ulcerations

6 Se co nd

po in t sk in W W id e id e N

Day 14

N kn ot

Result: BarbedWideN

Day0

Day14 Day 14

Day7

Result:BarbedWideN Squareknottowardshead

Day0 Day 0

Day14 Day 14

Day7

(Preliminary) Conclusions: Alternative Approach

Further analysis and testing
Smaller suture Test other patterns

Redness and ulcerations improve with time Conduct a field tagging study
Using most viable material above Include tag loss study Histopathology to indicate if healing is normal

20

Acknowledgments

PNNL: Piper Benjamin Scott Carpenter Jessica Carter Marybeth Gay Greg Gaulke Kasey Knox

Andrew Gingerich Tyrell Monter Bob Mueller Brett Pflugrath Andy Solcz John Stephenson

21