Woodley 2

Advances in Suturing Technique and Materials for Surgically Implanting Transmitters in 

Juvenile SalmonidsJuvenile Salmonids

Christa Woodley Katherine Deters Kathleen CarterChrista Woodley, Katherine Deters, Kathleen Carter, James Boyd, Jennifer Panther and Richard Brown

Pacific Northwest National Laboratoryi hl dRichland, WA

And M. Brad Eppard

United States Army Corp of EngineersPortland District, Portland, OR, ,

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Background

US ACE has funded the Tag Effects study since 2006

> 60,000 juvenile salmon from Snake & Columbia implantedJuvenile 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 techniqueAlternative suturing technique

Problem

Current technique and traditional sutures in general can cause:

UlcerationInflammationH h i &/ ti (“R d ”)Hemorrhaging &/or congestion (“Redness”)Fungal growthSecondary infectionSecondary infection

Achieve good appositionL f Low surface area

Has high tag retention Robust to surgeon skills

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Robust to surgeon skills Appropriate for large scale operations

What should sutures do?

Keep the incision closedKeep the incision closed

Cause minimal traumaCause minimal trauma

Keep transmitters retainedKeep transmitters retained

Sutures remain until the incision is healedSutures remain until the incision is healed

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Goals: Traditional Approach

Suturing technique that causes the least trauma g qto 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 tagCombined mass 0.54 g in airMean Tag Burden = 4 0% (2 5 5 8)Mean Tag Burden = 4.0% (2.5-5.8)

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

3 S3 Surgeons

Water temperature 12 or 17°CWater temperature 12 or 17 C

Weekly Examinations and Images

Day 7 – Day 28

Response VariablesSuture Retention (presence/absence)R d ( d)Redness (measured)Ulceration (measured)Fungus (observed)Fungus (observed)Incision Openness (measured)Necrosis (observed)

Treatments: 5 Suturing Techniques

1 x 1 x 1 x 1 2 x 2 x 2 x 22 x 1 x 1 x 1 2 x 2 x 2 x 2Two discontinuousTwo discontinuous

Horizontal MattressHorizontal Mattress(2 x 1 x 1 x 1)

Results: Redness

Day 7 Day 14

m2 ) 0.5

0.6 12°C17°C

ness

(mm

0.3

0.4

Red

n

0 0

0.1

0.2

1 x 1

2 x 1

2 x 2

2 x 2 D

oubleHor. m

attres

s0.0

1 x 1

2 x 1

2 x 2

2 x 2 D

oubleHor. m

attres

s

9

2 Ho 2 Ho

Results: Ulcerations

Day 7 Day 14

m2 )

0.3

0.4 12°C17°C

ratio

n (m

m

0.2

Ulc

er

0 0

0.1

1 x 1

2 x 1

2 x 2

2 x 2 D

oubleHor. m

attres

s0.0

1 x 1

2 x 1

2 x 2

2 x 2 D

oubleHor. m

attres

s

10

2 Ho 2 Ho

(Preliminary) Conclusions: Traditional Approach

Testing and analysis is ongoingGeneral trends –

1 JSATS tag expelled (out of 540 fish)Ulceration tends to increased over time for horizontal mattressmattressRedness tends to increase over time for double 2X2Suture retention lower among 1X1 than 2X2 for less trained surgeons

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Why do an “Alternative” Approach?

Traditional sutures tend to:

Hi h fil t h l fHigh profile sutures have large surface area attracts microbial and fungal growth

UlcerationsSuture knots, tissue tearing

Inflammation

Poor Apposition

Hemorrhaging &/or Congestion (“Redness”)

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ppDifficult to meet thin tissue layers

Methods: Knotless sutures

Quill SRSWorks on tension and angle of tension to maintain itsWorks on tension and angle of tension to maintain its positionMade for cosmetic and internal surgery

“grabbing” tissue

Disadvantage:3‐0 MONODERM7cm X 7cm 3/8 Circle 18mm Diamond Point

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Methods: Using full suture

Barbed “Wide-N”Barbed “6-point”

Whole suture

Barbed 6-point

SecondSecond Insertion

External Internal

Initial Insertion

Exit

Methods:

Barbed “Wide-N” with a square knot

Barrier Film

Second

- 2 discontinuous sutures

Second Insertion

Internal

- 2x2x2x2 knot

ExternalInitial Insertion

Results: Redness

Day 72 5

Day 14

mm

2 ) 2.0

2.5 12°C17°C

edne

ss (m

1.0

1.5

nt in N ot

Re

0.0

0.5

nt in N ot

6 point

Second sk

in

Wide NWide N

knot

6 point

Second sk

in

Wide NWide N

knot

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Results: Ulcerations

Day 72.8 12°C

Day 14

(mm

2 )

2.0

2.412°C17°C

lcer

atio

n

0.8

1.2

1.6

int

kin e N not

Ul

0.0

0.4

int

kin e N not

6 poin

Second sk

i

Wide NWide N

kno

6 poin

Second sk

i

Wide NWide N

kno

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Result:Barbed “Wide‐N”

Day 0Day 14Day 14

Day 7

Result: Barbed “Wide‐N” Square knot towards head

Day 0 Day 14Day 0 Day 14

Day 7

(Preliminary) Conclusions: Alternative Approach

Further analysis and testingSmaller sutureSmaller sutureTest other patterns

Redness and ulcerations improve with time

Conduct a field tagging studyUsing most viable material aboveInclude tag loss studyInclude tag loss studyHistopathology to indicate if healing is “normal”

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Acknowledgments

PNNL:PNNL:Piper Benjamin Scott Carpenter

Andrew GingerichTyrell MonterScott Carpenter

Jessica CarterMarybeth Gay

Tyrell MonterBob MuellerBrett PflugrathMarybeth Gay

Greg GaulkeKasey Knox

Brett PflugrathAndy SolczJohn StephensonKasey Knox John Stephenson

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