Surgery Overview

BIOPSIES

GENERAL INFORMATION

Type and extent of treatment depends on tumor type, whether the mass is in a difficult location for reconstruction, and whether the diagnosis could change the treatment plan.
Pretreatment biopsy is NOT indicated if knowledge of the type would not alter therapeutic regime or when the biopsy procedure is as dangerous as the treatment.

MOST COMMON COMPLICATIONS AND DIFFICULTY

Failure to obtain a diagnostic sample.
Not going deep enough into the tumor for a diagnostic biopsy. Many times the biopsy is only into the peritumor tissue or capsule/pseudocapsule tissue.
Biopsy location poorly planned in regards to definitive surgery and closure.

"EXPERTS' ADVICE"

It is often preferable to obtain a large biopsy sample from the center of the mass to secure the diagnosis.

LIVER BIOPSY
Biopsy of the hepatic margin by the "guillotine" method. Place a loop of suture around the protruding margin of a liver lobe. Pull the ligature tight and allow it to crush through the hepatic parenchyma before trying it. Using a sharp blade, cut the hepatic tissue approximately 5mm distal to the ligature. As an alternative, place several overlapping guillotine sutures around the margin of the lesion and excise it.

A circular Baker punch is an easy way to obtain a skin biopsy and the wound can be closed with a simple interrupted or cruciate mattress suture pattern. The Baker punch can also be used to obtain intestinal or liver biopsies as well and similar closure patterns can be used. The liver can also be biopsied using a guillotine technique where the suture is used to slice through the organ and left behind as a ligature.

BIOPSIES:
SUTURE AND NEEDLE OPTIONS

Brand

Needle Type

Needle Reference

Main Choice

Also Possible

Main Choice

Also Possible

LIVER/INTESTINE

MONOCRYL*

Taper Point

Reverse Cut

RB-1, SH

SH-1, CT-3

FS-2, FS-1

SKIN

ETHILON*

PROLENE*

Taper Point

Reverse Cut

RB-1, SH

SH-1, CT-3

FS-2, FS-1

LINEA ALBA

MONOCRYL* (young)

PDS* II (adult)

VICRYL* PLUS

Taper Point

Reverse Cut

SH-1, SH, CT-2, CT-1

RB-1, CT-3

FS-2, FS-1, FS, FSL, X-1, CP-2, CP-1

SUBCUTANEOUS

Taper Point

RB-1, SH, CT-2, CT-1

SKIN CLOSURE

ETHILON*

PROLENE*

Silk

Reverse Cut

FS-2, FS-1, FS

FSL, CP-2, CP-1, KS

Blue type indicates Reverse Cut

	Cat/Small Dog (20 lbs or less)	Medium Dog (20-45 lbs or less)	Large Dogs (50 to 75 lbs)	Giant Dog (75 lbs +)
LIVER/INTESTINE	4-0 or 3-0	4-0 or 3-0	3-0	3-0
SKIN	4-0 or 3-0	4-0 or 3-0	3-0	3-0
LINEA ALBA	3-0	3-0 or 2-0 or 0	2-0 or 0	0 or 1
SUBCUTANEOUS	4-0	4-0 or 3-0	3-0 or 2-0	2-0
SKIN CLOSURE	4-0	4-0 or 3-0 or 2-0	3-0 or 2-0	2-0

	Use the suture selection tool for specific product code recommendations.

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