Veterinary Surgery February 2026 – Soft Tissue Part 1: Feline Perfusion & Barbed Gastropexy Speed

In this Simini Small Animal Surgery Podcast episode, we kick off our soft tissue coverage from the February 2026 issue of Veterinary Surgery with two studies that highlight how small technical decisions can have major physiologic consequences.

From cutaneous perfusion in feline closures to time-saving strategies in GDV surgery, these papers challenge everyday assumptions and offer practical ways to improve outcomes in both routine and emergency procedures.

In this episode:

✅ Bayrakdarian et al. — A controlled, within-animal study evaluating continuous intradermal suture patterns in feline skin using laser Doppler imaging. The traditional horizontal mattress pattern decreased perfusion by 24.1%, while a modified pattern with perpendicular bite orientation increased perfusion by over 115% compared to baseline. The findings suggest that suture orientation—not just tension—plays a critical role in preserving microvascular blood flow in cats. 

✅ Chik et al. — A retrospective study of 121 dogs undergoing GDV surgery, comparing barbed suture gastropexy (BSG) to standard incisional gastropexy (SIG). The barbed technique reduced surgical time by ~10 minutes (53.3 vs. 62.6 minutes) without increasing complications, mortality, or recurrence rates. However, 23% of dogs in both groups experienced chronic postoperative GI signs, highlighting that gastropexy prevents rotation—not underlying gastrointestinal disease. 

Together, these studies reinforce a key concept: how we close—and how efficiently we operate—directly impacts both immediate and long-term patient outcomes.

🎓 Journal Articles Discussed

• Bayrakdarian et al. — Comparison of the effect on blood flow of two intradermal suture patterns in feline skin: A within-animal randomized controlled trial
• Chik et al. — Comparison of short-term outcomes and recurrence rates in dogs undergoing open right-sided barbed suture gastropexy and standard incisional gastropexy for treatment of gastric dilatation-volvulus

📚 From the February 2026 issue of Veterinary Surgery

🎁 Want to learn more about Simini Protect Lavage or request a sample?

Learn More:
 www.simini.com

Request a Sample:
https://www.simini.com/evaluation-kit

Transcript

SPEAKER_00 0:04

Hi, I'm Carl Damiani, and this is the Simene Small Animal Surgery Podcast, your fast focused update on what matters most from the latest small animal surgical literature. In each episode, we break down key articles from the veterinary journals and translate them into surgical insight you can use. Today, not someday. This episode kicks off our soft tissue coverage from the February 2026 issue of veterinary surgery, and we're honing in on two deceptively simple but clinically important questions, how we close and how we prevent recurrence. First, we'll look at a study by Bayreck Darien et al. comparing two intradermal suture patterns in feline skin and specifically how they impact wound perfusion. This is a controlled within animal study using laser Doppler imaging, and the findings challenge a technique many of us use every day. We'll break down what actually happens to blood flow at the incision margin and why bite orientation might matter more than you think. Then we move to Chick et al. who evaluated barbed suture gastropexy versus standard incisional gastropexy in dogs with GDV. This is a large clinical series with real-world relevance, looking at surgical time, complications, recurrence, and long-term outcomes. We'll focus on what changes with barbed suture, what doesn't, and how this might influence your approach in an already high-stakes emergency. Two studies, one shared theme, small technical decisions, suture pattern, suture type can have outsized effects on outcomes. Let's dive in.

SPEAKER_02 1:42

What if the very suture

Bayrakdarian et al. Study: Comparing Wound Perfusion in Feline Skin Closed via Traditional Horizontal Mattress (SP) vs. Modified Continuous Allgöwer-Donati (MAD) Suture Patterns

SPEAKER_02 1:45

pattern you use to close a feline spay is quietly choking off the blood supply to the incision? Welcome to today's deep dive, where our mission is to turn recent peer-reviewed veterinary literature into, well, surgical intelligence you can use tomorrow in the OR.

SPEAKER_03 2:00

Aaron Powell Right. And today we are looking at some truly fascinating data showing that pulling a suture tight can actually um increase acute blood flow by over 115% compared to baseline.

SPEAKER_02 2:11

Aaron Ross Powell Which sounds completely counterintuitive.

SPEAKER_03 2:14

Right.

SPEAKER_02 2:14

But before we get there, we are pulling this clinical intelligence directly from Baric Darien et al. 2026.

SPEAKER_03 2:20

Aaron Ross Powell Yeah, and the authors investigated a really well-known challenge, which is feline wound healing. Because, you know, compared to dogs, cats have a naturally lower cutaneous vascular density. Right. I mean, their skin is poorly perfused to begin with and just notoriously prone to slower granulation.

SPEAKER_02 2:36

Aaron Powell I always kind of picture feline skin as like a low pressure irrigation system.

SPEAKER_03 2:40

No, that's a good way to look at it.

SPEAKER_02 2:41

Aaron Powell Yeah, because every single drop of blood flow matters to prevent dehesance. If you pinch the hose even a little bit, the entire system just struggles to keep the tissue viable.

SPEAKER_03 2:51

Exactly. So the Barak Darien study asked how different continuous intradermal suture patterns physically affect that blood flow in feline spay incisions.

Within-Animal Study Design: Analyzing the split-incision randomized trial of 32 cats comparing SP and MAD patterns

SPEAKER_03 3:00

They actually set up a within animal randomized trial.

SPEAKER_02 3:03

Oh, so they use the same cat for both techniques.

SPEAKER_03 3:05

Right, exactly. 32 cats in total. They basically split each incision right down the middle. One half was closed with a traditional horizontal mattress pattern, which they label the SP pattern.

SPEAKER_02 3:16

Okay, got it.

SPEAKER_03 3:17

And then the other half was closed with a modified continuous all-gower Donati pattern, or MAD for short. So same cat, same incision, just two different closure techniques.

SPEAKER_02 3:27

Let's get right to the data then. I mean, what actually happens to the perfusion?

SPEAKER_03 3:30

Well, the horizontal mattress pattern decreased cutaneous perfusion by 24.1% from baseline.

SPEAKER_02 3:36

Wow.

SPEAKER_03 3:36

But the MEMAD pattern, it increased perfusion by 115.3%.

SPEAKER_02 3:41

Wait, hold on a second. I have to push back on that. How can pulling a suture tight actually increase blood flow compared to baseline? Because you are literally tying tissue together, you know?

SPEAKER_03 3:53

I know, it sounds totally backwards, but it really comes down to the physical mechanics of the cut and the closure. So normal inflammation from a surgical incision naturally causes vasodilation, right?

SPEAKER_02 4:04

Right, because the body is trying to send blood to heal the area.

SPEAKER_03 4:07

Aaron Ross Powell Exactly. But the horizontal mattress takes dermal bites parallel to the wound margin. It essentially acts like a clamp kinking the incident feeder arterials.

SPEAKER_02 4:16

Aaron Powell So you're basically stepping on the hose of our low pressure irrigation system.

SPEAKER_03 4:20

Aaron Ross Powell That is exactly it. The MAIDI pattern, on the other hand, takes its bites at 90 degrees to the incision. And that orientation runs parallel to the feeder vessels.

SPEAKER_02 4:30

Ah, so it avoids pinching them off.

SPEAKER_03 4:33

Right. It spares the microcirculation. Yeah. And that allows that natural vasodilatory healing response to actually happen. Aaron Powell Wow.

Simini Protect Lavage Study: Addressing the 42% bacterial remainder of standard saline vs. the 0% baseline achieved by antimicrobial lavage at closure

SPEAKER_02 4:40

Okay, so the MAIDI pattern is doing all that heavy lifting to keep the tissue perfused. You really cannot afford to waste that advantage by, say, closing bacteria into the site.

SPEAKER_03 4:49

Absolutely not. I mean, optimizing that closure step clearly has to include your site preparation. That is where the surgical continuum connects.

SPEAKER_02 4:57

Aaron Powell Right, because rinsing the site with saline just before closing is such a common habit for you in the OR. But clinical data shows normal saline actually leaves 42% of bacteria behind in the surgical site.

SPEAKER_03 5:09

Yeah, 42% is a massive blind spot.

SPEAKER_02 5:12

It really is. I mean, if saline is leaving nearly half the bio burden behind, what is the alternative for clearing the site effectively before you tie off that MAD pattern?

SPEAKER_03 5:22

Well, in independent head-to-head studies, Semini Protect lavage left 0% of bacteria behind. It is a 60-second non-antibiotic lavage. And instead of just, you know, pushing fluid across the tissue, it actively removes what saline misses by breaking down the surface tension.

SPEAKER_02 5:40

Oh, so it mechanically lifts the bacteria right out of the tissue bed.

SPEAKER_03 5:43

Exactly. It reinforces your infection control protocol without really altering your existing surgical workflow at all.

SPEAKER_02 5:49

Aaron Powell So we are looking at a sort of dual approach to closure here. You optimize the perfusion mechanically with the suture pattern, and then you clear the biological burden before you seal it up.

SPEAKER_03 6:00

Aaron Ross Powell That is the big clinical takeaway for the surgeon today. The MAD pattern is just a highly effective alternative to the traditional intradermal pattern in cats.

SPEAKER_02 6:09

Aaron Powell And it maintains the cosmetic advantages of a buried closure, right?

SPEAKER_03 6:12

Right. While actively improving that wound margin perfusion.

SPEAKER_02 6:16

Aaron Powell Which is incredible. So to leave you with a thought, if traditional horizontal sutures quietly restrict blood flow and normal saline leaves nearly half the bacteria behind, what other everyday OR habits are

Chi}k et al. Study: Multi-Center Retrospective Evaluation of Barbed Suture Gastropexy (BSG) vs. Standard Incisional Gastropexy (SIG) for Acute GDV

SPEAKER_02 6:30

you performing that might be silently undermining your surgical success?

SPEAKER_03 6:33

It really makes you think.

SPEAKER_02 6:34

It does. Next time you look at that low pressure irrigation system, you know, you might just wonder, what else is kinking the hose?

SPEAKER_01 6:45

Let's explore another relevant study.

SPEAKER_02 6:52

You know the feeling. You're standing at the OR table looking down at a hemodynamically unstable dog with an acute GDV. It's uh it's that terrifying twisted stomach situation.

SPEAKER_03 7:03

Right, exactly. The worst case scenario.

SPEAKER_02 7:05

And the clock is just loudly ticking in the background. Every single minute that compromised patient spends under anesthesia represents a, you know, a very significant tangible risk.

SPEAKER_03 7:15

Aaron Powell Yeah. You need to be effective, but you really need to be fast.

SPEAKER_02 7:18

Trevor Burrus, Jr. Right. Which brings us to a recent paper, Chick It All, 2026. We're doing a deep dive today to see if swapping the standard incisional gastropexy, the SIG, for an open right-sided barb suture gastropexy, or BSG, actually saves you crucial OR time.

SPEAKER_03 7:33

Aaron Powell Exactly. And doing that without sacrificing patient outcomes, that's the real mission here. I mean, time is tissue, but in these critical cases, time is also cardiovascular stability.

SPEAKER_02 7:42

Aaron Powell Absolutely. So how did they actually test this?

SPEAKER_03 7:45

Aaron Powell Well, this retrospective cohort study looked at 121 dogs that were surgically treated for GDV.

SPEAKER_02 7:52

Okay, a pretty good sample size.

SPEAKER_03 7:53

Aaron Powell Yeah. And they put the incisionless BSG head to head against the gold standard SIG. And the clinical punchline is well, the BSG is significantly faster.

SPEAKER_02 8:03

Aaron Powell How much faster are we talking?

SPEAKER_03 8:04

Aaron Powell So when performed as the sole procedure, BSG took a median of 53.3 minutes. That's compared to 62.6 minutes for the SIG.

SPEAKER_02 8:13

Oh wow. I mean, shaving nearly 10 minutes off anesthesia time in a compromised patient is massive.

SPEAKER_03 8:20

It really is.

SPEAKER_02 8:20

So it sounds like using this knotless barb suture is essentially swapping out a row of individual buttons for a heavy-duty zipper.

SPEAKER_03 8:27

I actually love that analogy.

SPEAKER_02 8:29

Right. Like you get the exact same secure hold, but you drantically cut down the mechanical workload of tying all those individual knots and making deep incisions.

SPEAKER_03 8:37

Aaron Powell That zipper analogy definitely holds up in the data too, because I mean saving 10 minutes is only valuable if the stomach actually stays put when the dog goes home and

Safety and Recurrence Metrics: Confirming equivalent safety with comparable recurrence rates and low perioperative mortality (3% for BSG vs. 8% for SIG)

SPEAKER_03 8:45

eats a large meal. Aaron Powell Yeah.

SPEAKER_02 8:46

So does the zipper actually hold? What's the safety profile look like?

SPEAKER_03 8:49

The safety profile is solid. There was no statistical difference in perioperative mortality between the two groups.

SPEAKER_02 8:55

Good to hear. What were the exact numbers there?

SPEAKER_03 8:57

It was 3% for the BSG group versus 8% for the SIG group.

SPEAKER_02 9:02

Okay, got it.

SPEAKER_03 9:03

And furthermore, there was no difference in overall complication rates or GDV recurrence.

SPEAKER_02 9:08

Wait, hold on. I need to push back on the biology here for a second.

SPEAKER_03 9:10

Sure. Go ahead.

SPEAKER_02 9:11

If you aren't actually cutting into the seromuscular layer of the stomach, how are you getting a permanent adhesion? I mean, that defies the traditional mechanics we're taught about creating a pexie.

SPEAKER_03 9:22

It does sound a bit counterintuitive at first, but the secret is in the procedural nuance and the actual suture material itself.

SPEAKER_02 9:30

Okay, explain that.

SPEAKER_03 9:31

So the surgeon uses electrosurgery to simply abrade the pyloric antrum and the body wall rather than actually cutting through the tissue.

SPEAKER_02 9:40

Right, just roughing it up basically.

SPEAKER_03 9:41

Exactly. And then the single-line barb suture does the heavy lifting. Unlike a smooth standard suture, those microscopic barbs continuously micro-traumatize the tissue along the entire line.

SPEAKER_02 9:53

Ah, so that physical irritation provokes a highly localized, intense inflammatory response.

SPEAKER_03 9:59

Aaron Ross Powell You nailed it. It's that specific targeted inflammation that acts as the catalyst. It generates enough scar tissue to create a robust, lasting adhesion without the need for a deep incision.

SPEAKER_02 10:11

Aaron Powell That is wild. The suture itself

Managing Long-Term Expectations: Addressing the reality that 23% of dogs in both cohorts still experience chronic postoperative gastrointestinal signs

SPEAKER_02 10:15

basically becomes the mechanism for the scar. Yeah. That is a brilliant use of the body's own inflammatory response.

SPEAKER_03 10:21

Aaron Powell It really is. But you know, even with a perfectly anchored stomach, these dogs aren't completely out of the woods long term.

SPEAKER_02 10:27

Right. There's always a catch. What's the issue?

SPEAKER_03 10:29

Well, a crucial piece of data from this study is that 23% of dogs in both groups still had chronic post-op gastrointestinal signs.

SPEAKER_02 10:38

Oh, like intermittent bloating or vomiting.

SPEAKER_03 10:40

Precisely. So as a surgeon, you must set realistic long-term expectations for the owners. The surgery fixes the life-threatening rotation, but it doesn't automatically erase underlying GI inflammation or motility issues.

SPEAKER_02 10:52

Right. The PEXI keeps the stomach from twisting again, but it doesn't magically cure the gut. So boiling all this down for the surgeon walking into the OR tomorrow, what is the ultimate takeaway?

SPEAKER_03 11:02

The big takeaway is that open barbed suture gastropexy is a faster, equally safe alternative to the standard incisional gastropexy for acute GDV management. Fantastic. Yeah, it basically allows you to confidently reduce anesthetic time and compromise patients without cutting corners on efficacy.

SPEAKER_02 11:19

That is a massive win for anyone standing over that OR table listening to the ticking clock of the anesthesia monitor.

SPEAKER_03 11:26

Absolutely.

SPEAKER_02 11:27

And it raises a fascinating question, you know. If barred sutures and simple electrosurgical abrasions perform this well without deep incisions in an acute life or death emergency, could this inflammatory, incisionless approach soon replace standard suturing and incising in other common abdominal procedures?

SPEAKER_03 11:44

All right, that is definitely something to think about.

SPEAKER_02 11:46

Definitely. Full article links for Chick et al. 2026 are available in the show notes for you to review. Check those out, and we will catch you on the next deep dive.

SPEAKER_01 11:58

That's it for this episode of the Simony Small Animal Surgery Podcast. This show is brought to you by Simony Protect Livage, our interoperative lavage developed to target resistant bacteria and biofilms where traditional solutions of saline and post op antibiotics fall short. If you're interested in learning more or trying out your own procedures, you'll find information and links in the show notes. For listening, and we'll see you in the next episode.