Veterinary Surgery February 2026 – Soft Tissue Part 3: Lung Lobectomy Ligatures & Omental Graft Reconstruction

In this Simini Small Animal Surgery Podcast episode, we wrap up our soft tissue coverage from the February 2026 issue of Veterinary Surgery with two studies that expand your surgical toolbox using practical, adaptable techniques.

From cost-effective lung lobectomy closure methods to biologically driven wound reconstruction, these papers challenge reliance on expensive tools and highlight the power of mechanics and tissue biology working together.

In this episode, we talk about:

✅ Cronin et al. — A large clinical series evaluating hilar circumferential ligature techniques for lung lobectomy in dogs and cats. The study reported a low intraoperative hemorrhage rate of 4.3%, with no difference between pre-tied loops and hand-tied knots. However, sliding knots showed a dramatically higher hemorrhage rate (28.6%), reinforcing that knot selection—not just technique—directly impacts safety in thoracic surgery. 

✅ Makar et al. — A retrospective case series describing free autologous omental grafts for large distal limb wounds in dogs. Despite initial graft discoloration and heavy discharge, all wounds healed successfully, shrinking to ~19% of original size by 30 days and achieving full epithelialization in an average of 59 days, with no major complications or long-term lameness. The omentum’s angiogenic and immunologic properties allowed it to revascularize and control infection even in contaminated wounds. 

Together, these studies reinforce a key principle: effective surgery doesn’t always require more technology; sometimes, it requires a better understanding of mechanics and biology.

🎓 Journal Articles Discussed

• Cronin et al. — Perioperative outcomes of 65 dogs and 15 cats undergoing lung lobectomies with a hilar circumferential ligature.
• Makar et al. — Autologous, free omentum grafts for large, open, distal limb wounds in dogs: Technique and outcome in 10 dogs.

📚 From the February 2026 issue of Veterinary Surgery

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Transcript

SPEAKER_01 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 continues our soft tissue coverage from the February 2026 issue of veterinary surgery, and we're focusing on thoracic decision making and advanced wound reconstruction. First, we'll look at a study by Cronin et al. evaluating peroperative outcomes of lung lobectomy using a halar circumferential ligature technique. Across 80 dogs and cats, complication rates were low, with minimal hemorrhage and few major postoperative issues, supporting this as a cost-effective and practical alternative to stapling devices, especially in smaller patients or resource-limited settings. Then we turn to Makar et al. who described the use of free autologous omentum grafts for large distal limb wounds in dogs. This is a fascinating biologic approach, leveraging the omentum's angiogenic and immunologic properties, and the results show reliable healing, excellent function, and good cosmesis, even in challenging wounds where traditional grafting may struggle. Two studies, one shared theme, expanding your surgical toolkit with techniques that are not just effective, but adaptable to real-world practice. Let's dive in.

SPEAKER_00 1:40

So um imagine you're closing up a routine total lung lobectomy on like a small cat. Right. You're feeling confident, but then you go to seal the root of the lung, and you realize that the uh the bulky human-grade stapler you're using just doesn't quite fit the anatomy.

SPEAKER_03 1:55

Yeah, they can be huge.

SPEAKER_00 1:56

Exactly. It's expensive, it's cumbersome, and you're just left wondering if there's, you know, a better way. Well, today's mission is to extract the practical punchline from a 2026 paper by Cronin et al. to see what you can do differently in the R tomorrow.

SPEAKER_03 2:10

Aaron Ross Powell And this paper is great because it looks at 94 real-world lobectomies. They wanted to see if Hilar circumferential ligatures.

SPEAKER_00 2:17

Which is basically just securely tying a loop around the hylus, right?

SPEAKER_03 2:21

Exactly. The route where the bronchi and blood vessels enter the lung. They wanted to know if that could be a safer and honestly more cost-effective alternative to those massive linear staplers.

SPEAKER_00 2:31

Aaron Powell So I mean we're talking about swapping this straight, bulky industrial clamp meant for a massive cavity with like a highly tailored precision zip tie that actually conforms to the hylus.

SPEAKER_03 2:44

Aaron Powell That's a really good way to put it. And looking at the data, the overall intraoperative hemorrhage rate was incredibly low. It was just 4.3%.

SPEAKER_00 2:53

Wow, that is really low. Trevor Burrus, Jr.

SPEAKER_03 2:54

Right. They compared commercial pretied ligature loops against hand-tied knots.

SPEAKER_00 2:59

Yeah.

SPEAKER_03 2:59

And crucially, they found literally no difference in safety between those pretied loops and hand-tied uh rotor or modified Miller's knots.

SPEAKER_00 3:09

Aaron Powell So both handled the anatomy fine.

SPEAKER_03 3:11

Beautiful, yeah.

SPEAKER_00 3:12

But okay, I do have to push back on one detail here from the study.

SPEAKER_03 3:15

Sure.

SPEAKER_00 3:16

When surgeons used sliding knots, the hemorrhage rate spiked to 28.6%.

SPEAKER_03 3:21

Yeah. Two out of seven cases bleeding.

SPEAKER_00 3:23

Right. And the paper notes this wasn't quote unquote statistically significant because of the small sample size. But I mean, in a real world OR, a nearly 30% bleeding rate means a busy surgeon should probably just abandon sliding knots completely for this, right?

SPEAKER_03 3:37

Oh, absolutely. I mean, statistics rely on sample sizes, but your clinical judgment relies on risk management. And this really comes down to the mechanics of the knots themselves.

SPEAKER_00 3:45

Aaron Powell Because of the tissue type.

SPEAKER_03 3:47

Exactly. A sliding knot relies on unidirectional tension. But a bronchus isn't just some static squishy tube. It's cartilaginous.

SPEAKER_00 3:57

Right. It has rigid structure. Trevor Burrus, Jr.

SPEAKER_03 3:58

It has structure. And the internal airway pressures change constantly. So a sliding knot simply cannot dynamically grip that shifting rigid tissue the way, well, a modified Miller's knot can.

SPEAKER_00 4:10

Because the Miller's knot locks onto itself.

SPEAKER_03 4:13

Yes, it essentially locks down under pressure. Trevor Burrus, Jr.

SPEAKER_00 4:15

That structural mismatch makes perfect sense. And the stakes are so high here because when a knot slips on a bronchus, you don't just get bleeding. No, you don't. You risk a massive air leak and severe contamination just pouring straight into the chest cavity, which is, you know, exactly what surgery is trying to avoid, eliminating those blind spots and doubt.

SPEAKER_03 4:34

Exactly. A failed closure turns into a full-blown contamination crisis. And that actually brings up the secondary, often invisible risk of closure, which is leaving bacteria behind.

SPEAKER_00 4:44

Right, because when contamination happens, most of us just reach for standard saline to rinse the site.

SPEAKER_03 4:49

We do. But independent head-to-head studies show saline leaves a staggering 42% of bacteria behind in the surgical site.

SPEAKER_00 4:58

Leaving nearly half the bacteria behind right before you suture is a massive blind spot.

SPEAKER_03 5:02

It really is. Which is why Semini Protect Lavage is so relevant here. In those exact same independent studies, Semity Protect Livage left 0% of bacteria behind.

SPEAKER_00 5:13

Wait, zero percent? That's a huge difference.

SPEAKER_03 5:15

It's huge. It's a 60-second non-antibiotic lavage designed specifically for that critical moment just before closure. It removes the resistant bacteria and biofilms that saline just washes right over.

SPEAKER_00 5:27

So it reinforces your closure protocol without disrupting the workflow.

SPEAKER_03 5:32

Exactly.

SPEAKER_00 5:33

Okay, so if we pull the primary clinical insight from Cronin at all, for the veterinary surgeons listening right now, what's the bottom line for tomorrow morning?

SPEAKER_03 5:41

The clinical punchline is this for small animal lung lobectomies, commercial pretied loops or hand-tied rotor and modified Miller's knots are safe, cost-effective options.

SPEAKER_00 5:52

Just ditch the sliding knots.

SPEAKER_03 5:54

Ditch them. Leave the sliding knots out of your toolkit for this procedure, because they just can't handle the dynamic pressure of a bronchus.

SPEAKER_00 6:02

So I'll leave you with this. If a simple, cost-effective ligature can safely replace an expensive, cumbersome stapling device, well, what other bulky, costly tools are you currently using in your OR simply out of habit?

SPEAKER_02 6:18

Continuing with the next published study.

SPEAKER_00 6:25

Imagine trying to um zip up a tight leather glove over a really swollen hand.

SPEAKER_03 6:32

Oh yeah, it's virtually impossible.

SPEAKER_00 6:34

Right. And that is exactly what it feels like trying to close a massive distal limb wound in a dog. I mean, there's just zero spare skin down there. And, you know, traditional full thickness graphs face these huge failure and contracture rates.

SPEAKER_03 6:48

Aaron Powell Exactly. They just tend to melt away.

SPEAKER_00 6:50

Yeah. So welcome to the deep dive. Today is tailored specifically for all the small animal veterinary surgeons out there looking for actionable intelligence in the OR.

SPEAKER_03 6:59

Aaron Powell Because we are following the Semini Style Guide today, extracting the exact clinical punchline from a single recent paper.

SPEAKER_00 7:06

Trevor Burrus Right. We want to answer what should you do differently in surgery tomorrow.

SPEAKER_03 7:10

Well, the standard approach to that anatomical bottleneck, it usually involves like really expensive negative pressure wound therapy setups.

SPEAKER_00 7:19

Aaron Powell Or you're just accepting long, complicated second intention healing.

SPEAKER_03 7:23

Which nobody really wants. But uh there's a recent retrospective case series on 10 dogs. It's Makar et al. 2026, and it presents a completely different approach.

SPEAKER_00 7:32

Oh yeah, this one is fascinating.

SPEAKER_03 7:33

It really is. So instead of specialized equipment, the surgeons used free autologous omentum grafts for wound reconstruction.

SPEAKER_00 7:41

Wait, wait, let's unpack this for a second. A free graft. You're saying surgeons are completely detaching a piece of an internal organ with no active blood supply and just tucking it into a dirty wound.

SPEAKER_03 7:52

Aaron Powell That is exactly what I'm saying.

SPEAKER_00 7:54

Doesn't the momentum just, you know, die in necros without an immediate blood supply hooked up?

SPEAKER_03 7:59

Well, the biology here actually defies our standard expectations. I mean, the omentum isn't just fat, it is a regenerative powerhouse.

SPEAKER_00 8:07

Right. It has all those growth factors.

SPEAKER_03 8:09

Exactly. It is densely packed with VEGF, which is vascular endothelial growth factor, alongside pleurputin stem cells.

SPEAKER_00 8:17

Oh, wow.

SPEAKER_03 8:18

Yeah. So it establishes neovascularization so rapidly that it survives the ischemia.

SPEAKER_00 8:23

Which is just wild to think about. And what about the infection risk? Because these distal limb wounds are notoriously nasty.

SPEAKER_03 8:29

Well, it fights off bacteria amazingly well. Yeah. The omentum is loaded with lymphatic tissue and macrophages.

SPEAKER_00 8:35

So it's just actively engulfing debris.

SPEAKER_03 8:37

Right. It acts as a localized immune responder. In this study, it successfully fought off bacteria, even in historically infected, foul-smelling wounds where traditional grass would have just failed completely.

SPEAKER_00 8:49

Incredible. Yeah.

SPEAKER_03 8:50

You simply harvest it via small celiotomy, tack it to the deep tissues, and tuck the edges under the dermis. No microvascular anastomosis required at all.

SPEAKER_00 8:58

Aaron Ross Powell So no advanced vascular training needed. And the data from Mukar et al. 2026 is pretty striking. All 10 wounds completely epithelialized.

SPEAKER_03 9:09

Yeah, with zero major complications.

SPEAKER_00 9:11

Trevor Burrus Right, and zero long-term lameness. I mean the numbers are incredible. By 30 days post-stop, these massive wounds shrank to roughly 19% of their original size.

SPEAKER_03 9:21

They did, achieving full healing in an average of 59 days.

SPEAKER_00 9:25

That 59-day timeline is crucial to keep in mind, though.

SPEAKER_03 9:27

Oh, absolutely, because getting there requires a major adjustment in how you manage the postoperative phase.

SPEAKER_00 9:33

Yeah, there is a catch.

SPEAKER_03 9:34

Right. In the first one to two weeks, this graft produces a lot of copious discharge. And the tissue actually turns swollen, bruised, and frankly, black.

SPEAKER_00 9:42

Aaron Powell Right. It looks terrible. It's kind of like a kitchen remodel. You know, it looks terrifyingly destroyed before it actually gets better.

SPEAKER_03 9:48

That is a perfect way to put it.

SPEAKER_00 9:49

Yeah, because the superficial layers are sloughing off due to initial hypoxia, but that black bruised top layer is acting as a biological bandage.

SPEAKER_03 9:58

Exactly. It is protecting the deep vascular bed that is frantically building new supply lines. So the surgical intelligence here is basically don't panic.

SPEAKER_00 10:08

Which is hard. I mean, the hardest part for a surgeon here is fighting your own training. Your instinct when you see black discharging tissue is to immediately debride it.

SPEAKER_03 10:18

And you have to resist that urge. You absolutely cannot mistakenly de bride that active healing graph.

SPEAKER_00 10:24

Because you'd ruin it.

SPEAKER_03 10:26

Exactly. Underneath that superficial necrosis, the deeper omentum is forming a really robust pink bed of granulation tissue.

SPEAKER_00 10:34

You just have to manage it with frequent bandage changes in that first week, right?

SPEAKER_03 10:38

Yeah. Sometimes daily bandage changes just to clear the discharge, allowing the underlying tissue to establish itself.

SPEAKER_00 10:43

Aaron Powell So the take-home message here is that free omentum grafting is this robust, low-tech alternative to expensive NPWT for those large distal limb wounds, as long as you are prepared for intense bandage management in week one.

SPEAKER_03 10:56

It fundamentally changes the calculus for distal limb salvage just by leveraging the patient's own intense biological healing mechanisms.

SPEAKER_00 11:04

It really does. Which leaves you with this final provocative thought. If a free piece of momentum can spontaneously revascularize, fight off resistant infections, and even stimulate actual hair regrowth on a scraped-down distal limb, well, what other hopeless anatomical dead zones in veterinary medicine could we save just by borrowing from the abdomen?

SPEAKER_02 11:26

That's it for this episode of the Semini Small Animal Surgery Podcast. This show is brought to you by Semini 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. Thanks for listening, and we'll see you in the next episode.