Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
Taper vs. Cutting Needles for TPLO Closures: What Does the Evidence Say?
Ever notice how the smallest habits in surgery are the hardest to justify with data? We dig into one of those everyday choices—taper vs. reverse cutting needles for intradermal closure after TPLO—and unpack what the evidence actually says about early incisional healing, complication rates, and the subtle differences that might matter at the 18–24 hour mark. With surgeon-researcher Josh Becker, we trace the path from hunches and mentor preferences to a pragmatic study design that could live in private practice and still push the conversation forward.
We talk candidly about why “non-inferiority” can be a messy label without a clear gold standard, how blinding and standardized photos helped keep bias in check, and why the simplest takeaway is also the most practical: both needle types can perform well in healthy TPLO patients. Josh shares when he reaches for taper vs. cutting based on tissue characteristics and body region, and we explore the mindset shift from “what I’ve always used” to “what this patient and this tissue need today.” The conversation also opens a bigger door: if veterinary medicine had a validated, objective incision scoring system, we could compare techniques, icing and heat protocols, bandaging, and mobilization with far more confidence.
Looking ahead, we map out next steps—replicating signals, expanding to other anatomical sites, and experimenting with image-based analytics or AI to quantify erythema and bruising consistently. Along the way, we keep it human: debriefs after cases, the humility of soft tissue surgery, and advice for students who want to build a thoughtful, evidence-aware surgical career. If you’ve ever argued for a needle out of habit, this episode invites you to choose with intention and ask for proof.
If this conversation helped refine your setup or sparked a change in your closure routine, subscribe, share the episode with a colleague, and leave a review—your feedback helps more vets find data they can use tomorrow.
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SPEAKER_01:Welcome to Veterinary Vertex, the Avium Aid Journal's podcast, where we delve into the behind-the-scenes look with manuscript authors. I'm editor-in-chief Lisa Fortier, joined by Associate Editor Sarah Wright. Today we're discussing a study that compares clinical early incisional healing outcomes of TPLO incision closures when using reverse cutting or taper point needles for intradermal closure with the author of that manuscript, Josh Becker. Hey Josh, thanks for taking time out of your super busy schedule to be with us here today.
SPEAKER_03:Yeah, absolutely. Thank you for having me.
SPEAKER_02:So, Josh, before we dive in, can you share a little bit about your background and what brought you to suture needle selection research?
SPEAKER_03:Yeah. So as far as my research background goes, it kind of started in undergrad where I was first exposed to the ins and outs of research, like a whole research process. Um in bed school, I helped uh with some clinical research for a surgeon, uh, mostly just like data gathering and organizing um at school. And then um I also helped with some animal ethics publications um with a law school professor who also happened to lecture on animal ethics to the best students and veterinarians. Um I co-authored a book chapter on um single port uh minimally invasive techniques with one of my mentors during my surgical internship. And I've had a lot of uh fun fact, I still can't spell uh laparoscopic correctly, like half the time. But um I also participated in a few other projects and failed more times than I'd care to admit in trying to get some projects off the ground. Um, but uh it's all kind of led up to just um a fair amount of exposure to research. Um I just finished up my surgical residency. Um, so uh research is something I've always kind of been interested in and hope to continue well beyond residency. And uh yeah, uh what how that brought me to suture needle selection um was because um it's one something that's um been overlooked in the vet literature, and two, when coming from a busy um private practice setting, um, it was a accessible topic for me to really look into without having to necessarily have all the fancy equipment and specialized tools that you might get in an academic setting or like a highly specialized setting. So it was something that like I could potentially get good data on um and publish on while not necessarily having you know all the cool bits to really get more facts.
SPEAKER_01:Yeah, very clinically applicable. It's the first thing I ask people when they say, Oh, could you help me design a research project? What is your interest? And then they say what their interest is. I'm like, do you have the case number to support that? So well done to identify that. It sounds like you got good mentoring early on.
SPEAKER_03:Yeah, I was very lucky in that regard. So um hopefully I haven't embarrassed them with this paper.
SPEAKER_01:I think you probably found that luck. Uh, your this jab article uh discusses how taper needles are non-inferior to reverse cutting needles for intradermal closure for TPLO. Uh, I'm a surgeon too, and I know that these needles are for especially for intradermal people, have strong opinions, so shall we say? And I guess for me, I would have thought the difference between these was due to skin thickness, skin toughness. But uh, what was your motivation for this research?
SPEAKER_03:Um, really the lack of uh like empirical data out there in the vet literature and even in the human literature, it's uh also kind of debated, you know. Like you said, during my training, I had some mentors who had very strong opinions on the needle I ought to be using. Um, but then because they had such strong opinions, it it made me go, like, okay, well, where's your proof? So I'd look it up and be like, oh, here's some papers that say this and other papers that say that. But the more and more you look into it, there's there's no one that actually has anything to be like, look, this is what like we we tested this many patients, and this is the outcome, and this is why this is better. Um, and in fact, you know, there's contradictory papers and articles out there. So I was just like, let's try to actually pin something down here.
SPEAKER_01:Yeah, I like it. You already said one of the factors when considering the design was that you had an adequate case number to support or refute your hypothesis. And then the next thing would be your outcome measures. How did you define and measure non-inferiority in this context?
SPEAKER_03:Yeah, um, frankly, I think the use of the term non-inferiority from like a statistical standpoint is probably a bit of a misnomer. But um the problem was that for uh non-inferiority studies, we need that like non-inferiority margin to define, like, oh, you know, deviation this much from the outcome is what you can call like inferiority inferior or not inferior. But because we didn't have an established um, you know, this is the correct needle, this is the standard. Um it was more of a even if we found something um like we did in the paper, it was like, you know, there's evidence to show there might be a difference, we couldn't be like, hey, this is something we should look into further, not necessarily like this is the better needle. Um so really it was more like uh look, there's especially in this paper, there was no difference in clinical outcomes, but we did find some statistical difference in the you know 18 to 24 hour post uh incision check. Um, so that if we use the term non-inferiority, there's probably uh in hindsight a better way to state it, but um, for the sake of brevity for the title, and honestly, just for the lack of my ability to figure out a better term, I went with non-inferiority.
SPEAKER_01:So which needle does Josh Becker use?
SPEAKER_03:Um I do like the taper needle, at least with my TPLOs. Uh in the paper, you know, I do mention that it is probably different for different parts of the body. I mean, for an intact male, um like an abdominal closure, I'm going with the cutting. Yeah. Um, because I've definitely bent enough of those turn surgeries to be like, all right, nope, not working. Um, but here for TPLOs, yeah. Personally, I I've done enough TPLO engineer closures at this point where I'm like, yeah, let's go taper.
SPEAKER_02:Yeah, makes sense. Yeah, this research is moving the needle, no pun intended. That's terrible. I know. I've been thinking about that for like the last five minutes.
SPEAKER_01:Bad joke from here, I Lisa. Only from a non-surgeon would use that.
SPEAKER_02:Definitely non-surgeon over here. So, Josh, what are some of the key take-home messages you hope veterinarians will remember from this work?
SPEAKER_03:I mean, realistically, again, we can't say like this is the better needle. It's really our final suggests that the taper needle may have a benefit in the context of TPL intradermal closures. You know, that's a very narrowly defined uh window. But um, I think what may be cross-applicable, cross-applicable here is that uh thinking about all the little steps that you take in any surgery, every every tool, every technique, um, everything we do, really you need to think about it because it could have a difference in patient outcome. So being able to tailor that to every patient, every situation will make you a better surgeon.
SPEAKER_02:Yeah, like that's how you come up being intentional with your choices. I think that's important.
SPEAKER_03:Yeah.
SPEAKER_02:And how can veterinarians integrate these insights into their daily clinical routines?
SPEAKER_03:Kind of going into that same thought process, it's just mindfulness. Um, doesn't necessarily even need to be in surgery. Just again, always having a rationale and ideally some empirically driven data that can inform your decisions and your decision making.
SPEAKER_01:Okay, Josh, what's one lesson in life doesn't have to necessarily be in the OR that you learn the hard way, and how would you pass that on to surgeons? Again, it doesn't have to be surgical, it can be how to navigate a career, any anything like that.
SPEAKER_03:Honestly, it's easy for me to pick a surgical one because surgery is fickle, particularly soft tissue. Um, you know, orthopedics, you have that uh you've you usually know you've done it right or you've done it wrong pretty, pretty immediately, which is very gratifying. But with soft tissue, you'd be like, oh, that was the best one I've ever done, and then it blows up in your face, and you're just like, oh God, what have I done wrong? You're ripping out your hair, just thinking of all the things you could have done better, or looking back, you know, what what did I miss? Um, so I guess that that one lesson would just be like don't be too hard on yourself, but uh make sure you're thinking about everything. And really when those things do happen, you gotta do a good uh workup afterward to figure out why.
SPEAKER_01:Yeah, I like that. With my veterinary students and and my residents, when we were scrubbing, I would say, what did we do well last time on this surgery? What could we do better? And then when we're de-gowning uh or bandaging, and then the same thing. What did we do well? What can we do better? It could be communication, positioning, where were the radiographs? You know, we didn't have something prepared, uh, we didn't prepare with a technical team well enough. Uh, so I think being mindful and reflective, but don't again don't be too hard on yourself.
SPEAKER_03:Yeah. Yeah, there's I I'd never done or seen a perfect surgery. There's always something that could be better. So that's a good takeaway for that.
SPEAKER_01:Yeah, that is true. For veterinary students considering a surgical path, what advice would you give to them?
SPEAKER_03:Uh work hard, study, be a good student your whole career, and just love what you do. You know, if you're picking surgery, you should pick it because it's the coolest thing in the world.
SPEAKER_01:It is. Yep.
SPEAKER_03:Sorry, Sarah.
SPEAKER_02:No, it's okay. I was gonna say spoken again like true surgeons. So looking ahead, what are the next steps for research in this area?
SPEAKER_03:Well, since we did find, you know, some statistically significant data, I think really it's just being able to verify or disprove it at this point. Um, we touched upon it a little in the paper, but um we should be thinking about how to find more objective ways to evaluate the differences and verify that they exist or don't. And then what are the clinical implications of that? So um, you know, like I was saying, does it apply to different areas of the body for the differences we do find? Um, what does that mean for the patient and their outcomes? And really, how can we continue to build on that and apply it to better serve our patients?
SPEAKER_02:And are there any gaps or limitations in current knowledge that you think should be addressed first?
SPEAKER_03:Yeah, a big one would be like particularly for my study, what I found was that there's no objective metric in vetmed for wound assessment, like for incision healing. Um, there's a couple smaller studies. I referenced a few that um, you know, they they came up with um, you know, quantitative or semi-quantitative methods to try to objectively evaluate that. But um, there's nothing that's been value validated in vetmed, like we have you know, the animal trauma triage score, the glass-cauicoma scale, all of which have you know further studies to be like, look, this works and is accurate. We don't have that in uh you know on our side of the fence. Human medicine has a uh at least one. I I tried to rip as much from that as possible, but um, it's just not as cross-applicable to veterinary patients because you're not asking them, oh, do you smoke? Like, um, so there's there's less I can use for that. And so I think that would be a a great uh line of research for someone to really figure out and give us that tool.
SPEAKER_02:Maybe that someone can be you, Josh.
SPEAKER_03:Maybe I like my the the incision scoring system I came up with, but um again, I would like some validation. And one idea um that was tossed out that would have been really cool is maybe something AI driven or just uh computer driven based on the photos we took. And you know, you you quantify the length of the incision, you have it uh um standardized to the length, and then you can get like an area that's affected by like erythema, bruising, um something like that, and you can get actual percentages. But again, then the the same problem you got to validate it and all that. So someone smarter than me with electronics might be able to figure that out.
SPEAKER_01:But that would be super helpful too for postoperative care, icing, heat, mobilization, all of those things that we do and don't really know how much, even if it's increased vascularity or decreased, how does that affect wound healing? And Josh, you talked about uh the great exposure you had in undergrad and then as a resident. How did this training uh uh culminate and prepare you to write this article?
SPEAKER_03:Uh, I think really the biggest thing it did was really help me troubleshoot all of the robots we kind of encountered during the process. Um, you know, there's a lot of things that's from a third-party perspective when you're watching a study be conducted that you're not thinking about. And when you're actually doing it, you're just like, there's so many, and you you realize how many intangibles you you come up against, just like trying to get the clinic flow, trying to make sure that um, you know, uh you're you're gathering the data appropriately, that the patients are being handled appropriately, the clients are being handled appropriately, you know, you're you're crossing your T's, dotting your I's and um yeah, that was as frustrating as it was fun.
SPEAKER_01:There is a lot to it that people don't understand when they're just reading the article.
SPEAKER_03:Yeah, yeah, and and you realize too, like how fragile and how valuable that objective data is when you start to realize all the things you could do to screw it up.
SPEAKER_01:But you didn't.
SPEAKER_03:No, no, I worked very hard not to.
SPEAKER_01:So did all of this background give you a unique lens or a bias and that shaped how you interpreted the data? Or even acquired it or designed the study?
SPEAKER_03:Honestly, I I did come in with a huge bias in terms of my preference for needle, at least in TPLs, because I uh I felt anecdotally I thought I saw a lot more immediate post-ile bruising from the cutting needle. Um, so I had to really work hard to make sure that all the throughout the whole process, I was as blinded as possible to the uh I was blinded to the needle type when I was gathering my data. Um and it was surprising finding that, you know, oh I that anecdotal feeling. I was like, oh yeah, we're definitely gonna have more bruising from the the cutting needles. Watch this. And then it was like, oh, there was no difference. And oh, there's more urethema. Okay, sure. Like without expecting that. So um that was a fun little, oh, neat, that uh I came in with.
SPEAKER_02:It's always cool to see what the evidence shows us.
SPEAKER_03:Yeah.
SPEAKER_02:So, Josh, this next set of questions is gonna be really important for our listeners. These are our big take-homes. The first one's gonna be about the veterinarian's perspective. So, what is one piece of information the veterinarian should know about using reverse cutting or taper point needles for intradermal closure during TPLOs?
SPEAKER_03:They both work. Um, you know, our our our outcomes um for the patients were good either way. We didn't have any significant differences in the complication rates. Um, you know, the nice thing about TPLOs, especially in this population where we really tried to eliminate any confounding factors from like comorbidities, is TPLO patients are usually healthy, happy, young to middle-aged, you know, dogs that want to go back to ripping and tearing on the ground. So um, if there's a particular needle that a primary care veterinarian or surgeon feels that they have a better outcome with on their TPLO introdum closures, go for it.
SPEAKER_02:Um said. And for the clients, what's one thing you wish more people understood about this topic?
SPEAKER_03:It's not black or white. Um, you know, there's a lot of things in science and medicine where they're it's easy to form an opinion because of Dr. Google. But um, understanding there's a lot of clinical discretion and getting objective data is is hard.
SPEAKER_01:Thank you, Josh, for being with us. As we wrap up, we like to have a little bit of fun with a few questions. Uh so what is your favorite animal fact? You know, that fact that you dig out when conversation's a little bit at a lull and people are like, no, I didn't know that.
SPEAKER_03:Um, has anyone ever brought up uh the mating habits of deep-sea anglerfish? Um, no. That's a really fun one. Um so certain species, deep-sea anglerfish are probably one of the more extreme examples of sexual dimorphism in animals and have a very unique strategy to mating, which has been termed sexual parasitism. Um, so the male anglerfish is significantly smaller than the female. They have uh there's certain species that are literally unable to eat because they don't have an appropriately um formed digestive system. Um it's completely underdeveloped, and basically uh they're just swimming bags of gametes whose only purpose in life is to find a female, latch on, um, and at which point they become embedded to the female permanently, um, where they'll even start to share a blood system, uh, blood supply uh and are functionally just uh a set of gametes that they can use when appropriate.
SPEAKER_01:A sweep meet set of gametes. That's awesome. All right, well, uh let's see what you have for this one then. What do you think is the most beautiful animal?
SPEAKER_03:Look up the greater Po-2. That one just makes me laugh.
SPEAKER_01:Tell us what I don't know what that is.
SPEAKER_03:Uh the Greater Potu is one of the more it's uh common burden um South America. Uh really interesting looking animal, but um, I think they're gorgeous.
SPEAKER_01:So why? Why do you think it's so beautiful?
SPEAKER_03:Um makes me laugh.
SPEAKER_02:Okay, that's fair.
SPEAKER_03:Functional makes me laugh.
SPEAKER_02:Definitely gonna look that up after this. Can you spell it? I'm Richard, look it up.
SPEAKER_03:E-O-T-O-O.
SPEAKER_02:Okay, perfect. Thank you. Even the name is funny. Awesome. Well, thank you so much, Josh. We appreciate you being here with us today and also for sharing your words too with Javma.
SPEAKER_03:Yeah, thank you so much for having me. Um, and hopefully I can get another paper or two through you guys uh in the future.
SPEAKER_02:Awesome. We'll be looking forward to it for sure. And for our listeners, you can read Josh's full article on Javma. I'm Sarah Wright here with Lisa Fortier. Be sure to tune in next week for another episode of Veterinary Vertex. And don't forget to leave us a rating and review on Apple Podcasts or wherever you listen.
