A simple interrupted pattern and a simple continuous pattern are most commonly used, but how do you decide which one to use? Galina Hayes, BVSc, DVSc, PhD, DACVECC, DACVS, offers an answer.

What suture patterns should surgeons use in intestinal resection and anastomosis?

Galina Hayes, BVSc, DVSc, PhD, DACVECC, DACVS, an associate professor at Cornell University in Ithaca, New York, shares insight from her session on gastrointestinal tips for surgeons, which she presented at the 2025 New York Vet Show in New York, New York, on November 6, 2025. 

In this video, Hayes discusses 2 common suture patterns used in intestinal resection and anastomosis: the simple interrupted pattern and the simple continuous pattern. For surgeons working alone or with less experienced assistants, Hayes recommends the simple interrupted pattern, as it provides better control over placement and tension and is generally easier to perform than the continuous pattern.

The following is a transcript of the video, which has been lightly edited for clarity and cohesion.

Hi, my name is Galina Hayes. I'm a specialty soft tissue surgeon here at Cornell University in Ithaca in upstate New York. I've been teaching veterinary surgery for the last 12–13 years. I'm also boarded in emergency and critical care, which I find really helpful for preoperative and postoperative management of our trickier patients. Before I became a specialist, I worked in [emergency room] practice and before that, in small animal and mixed practice...

There are really 2 suture patterns that are used commonly in an intestinal resection and anastomosis, and those are a simple interrupted pattern, but also reported is a simple continuous pattern. Now, with the simple continuous pattern, you have an anchor knot at 180-degree intervals around the bowel, and it can be a little bit more difficult to control placement and tension without an assistant. So, for anyone who's working solo, or if maybe their assistant isn't [very] experienced, I would recommend a simple interrupted pattern—just as something that is easier and maybe less challenging to do if you're not doing these all the time.

Videos

What suture patterns should be used in intestinal resection and anastomosis?

The lateral washered-anchor extracapsular repair (washered-anchor technique) introduces a biomechanically stable modification of traditional extracapsular stifle stabilization. By using a washered screw at the tibial anchor site and either the lateral fabella or a second isometric femoral screw proximally, the construct approximates isometric tension across the stifle’s range of motion while providing robust lateral stability.

Unlike conventional soft tissue–anchored techniques, the washered-anchor approach preserves the medial aspect of the stifle, reducing soft tissue morbidity and improving postoperative recovery. This article reviews the rationale, surgical technique, and supporting biomechanical evidence based on published isometric mapping and extracapsular stabilization (ECS) studies. This approach provides a cost-effective, reproducible stabilization option for cases where tibial plateau leveling osteotomy (TPLO) or tibial tuberosity advancement (TTA) may be impractical.

Cranial cruciate ligament rupture remains one of the most common orthopedic causes of lameness in dogs. Although tibial osteotomy procedures such as TPLO and TTA achieve excellent outcomes, ECS continues to serve as a practical, cost-effective alternative for small- to medium-breed dogs or revision cases.

Traditional ECS techniques, such as the Flo and DeAngelis methods, rely on circumfabellar soft tissue loops, which are nonisometric and produce variable tension and suture elongation during flexion and extension.

 This variability contributes to residual laxity and inconsistent outcomes over time.

Advances in stifle biomechanics led to the mapping of quasi-isometric femoral and tibial points that maintain nearly constant interanchor distance through the range of motion.

 Building on these findings, the washered-anchor technique merges the familiarity of the lateral extracapsular repair with the mechanical predictability of bony, isometric fixation. The result is a stable, reproducible construct that eliminates cranial drawer while preserving the medial joint capsule.

A routine lateral parapatellar incision is made. The lateral fascia is reflected caudally to expose the lateral fabella and the caudolateral femoral condyle. Meniscal inspection and any necessary debridement or release are performed before stabilization.

Experimental work has confirmed that true isometric points do not exist, but quasi-isometric pairs provide minimal distance change during flexion and extension.

 This is identified on the caudal edge of the femoral condyle adjacent to the cranial pole of the lateral fabella.

This is located just distal and caudal to the insertion of the patellar ligament, immediately caudal to Gerdy tubercle—the prominence at the cranial aspect of the extensor fossa of the long digital extensor tendon—along the caudal edge of the tibial extensor groove.

These landmarks maintain a near-constant distance through flexion, reducing cyclic creep and preventing overconstraint.

A washered cortical screw is placed at the tibial isometric point to prevent suture cut-through and distribute load evenly.
The suture line—either monofilament nylon or ultrahigh molecular weight polyethylene, such as LigaFiba or FiberWire—is passed to the proximal anchor, which can be:

A second washered screw at the femoral isometric point for direct bony anchorage

This configuration reproduces the isometric trajectory demonstrated in biomechanical trials while permitting tension adjustment under direct visualization.

Tension is applied until the cranial drawer test is negative and tibial thrust is neutralized. The suture is secured under the washers, maintaining a consistent load without suture deformation. The stifle is closed in routine fashion.

The anatomical and functional relationship of the cruciate ligaments, as first described by Arnoczky and Marshall, provides essential insight into maintaining normal joint mechanics.

 They demonstrated that the cranial cruciate ligament undergoes predictable reciprocal tightening and loosening patterns through flexion and extension, underscoring the importance of isometric reconstruction.

Recent ex vivo biomechanical studies confirmed that ECS using bone anchors and monofilament nylon can restore near-normal stifle stability when placed at quasi-isometric points demonstrated that such placements limit cranial tibial translation (< 1.4 mm) while avoiding excessive internal rotation, validating the concept of controlled isometry.

The washered-anchor construct refines this by employing hardware that provides bony fixation rather than soft tissue anchorage, distributes tension evenly across a washer interface, and allows straightforward revision or retensioning if required.

The LigaFiba Iso Toggle guide further supports the precision of bony tunnel placement, noting the reproducibility of these quasi-isometric points in the lateral fabellar region and tibial crest.

 Early clinical outcomes demonstrate excellent postoperative limb function, particularly in small to medium breed dogs where TPLO or TTA may be cost-prohibitive or anatomically unsuitable.

The washered-anchor technique serves as a refinement of lateral ECS grounded in sound biomechanical evidence. By combining isometric anchorage with lateral-only access and load-distributing fixation, it provides enhanced stability, reduced tissue trauma, and a reproducible alternative to traditional fabellar sutures.

As studies continue to validate the use of bone anchors and quasi-isometric point mapping, this hybrid technique offers a promising balance of strength, adjustability, and surgical accessibility.

Flo GL. Modification of the lateral retinacular imbrication technique for stabilizing cruciate ligament injuries. 

DeAngelis M, Lau RE. A lateral retinacular imbrication technique for the surgical correction of anterior cruciate ligament rupture in the dog. 

Arnoczky SP, Marshall JL. The cruciate ligaments of the canine stifle: an anatomical and functional analysis. 

Hulse D, Hyman W, Beale B, Saunders B, Peycke L, Hosgood G. Determination of isometric points for placement of a lateral suture in treatment of the cranial cruciate ligament deficient stifle. 

. 2010;23(3):163-167. doi:10.3415/VCOT-09-05-0054

Roe SC, Kue J, Gemma J. Isometry of potential suture attachment sites for the cranial cruciate ligament deficient canine stifle. 

Hsu WR, Lin CC, Sun CY, Wu CH. Ex vivo biomechanical evaluation of extracapsular stabilization with quasi-isometric points in canine cranial cruciate ligament-deficient stifles. 

. 2023;19(1):93. doi:10.1186/s12917-023-03656-7

Veterinary Instrumentation. Accessed November 6, 2025. https://www.veterinary-instrumentation.com.au/wp-content/uploads/sites/7/2025/04/Vi-ANZ-Surgery-Guide-LigaFiba-Isotoggle-Issue-1-March-2023.pdf

Articles

A refinement of the lateral extracapsular repair.

The washered-anchor technique

Mastering Atopic Dermatitis: Multimodal Management for Holistic Control

: Nutramax Laboratories Veterinary Sciences

In this 50-minute webinar, Joya Griffin, DVM, DACVD, reviews the pathogenesis of canine atopic dermatitis and how to implement a systematic approach to achieve an accurate diagnosis. She also explores how to manage each atopic case based on the patient’s specific needs and how to control disease by implementing evidence-based treatments to reduce pruritus and prevent allergic flare.

How to Use IRIS Kidney Guidelines in Practice

: Korinn Saker, DVM, PhD, MS, DACVIM (Nutrition)

This presentation reviews the latest International Renal Interest Society (IRIS) staging information and published veterinary research on chronic kidney disease (CKD). Management involves more than medications alone. The benefits of incorporating targeted nutritional support as part of the patient’s management plan are discussed. Diet options to best manage changes in kidney function and strategies to introduce nutritional support intervention to your patients with CKD are shared. Participants will access a comprehensive list of recommended commercial diets and receive insight into specific diet similarities and differences to assist in making appropriate diet recommendations.

: Mary Anna Labato, DVM, DACVIM (SAIM), ACVNU

This lecture presents ways to manage chronic kidney disease (CKD) in dogs and cats. It examines what is new and what is on the horizon to improve quality of life for patients. The lecture reviews how we should think about chronic kidney disease and its progression, and how new management techniques may influence progression of disease.

Puffy Eye… Maybe It’s Feline Herpesvirus?

: David J. Maggs, BVSc (hons), DACVO, MANZCVS

Feline herpesvirus (FHV-1) is a common pathogen of cats and kittens worldwide, producing a wide variety of ocular manifestations from mild conjunctivitis to blinding keratitis or symblepharon. In this session, we discuss how to reach a diagnosis of FHV-1 and how best to manage it.

Senior Renal Care/CKD: Early Diagnosis and Slowing Progression With a Multimodal Approach

: Gregory F. Grauer, DVM, MS, DACVIM (SAIM)

Early diagnosis of chronic kidney disease (CKD) gives us the best opportunity to slow the progressive nature of the disease and buys time for client education to increase client adherence. International Renal Interest Society CKD staging can be used to tailor CKD treatments to patients based on their stage of disease.

Practical Corneal Ulcer Management for General Practitioners

Participants will learn about corneal anatomy and how it pertains to our understanding of ulcer management. This program delves into the specifics of recognizing and managing corneal ulcers from superficial to deep, in addition to reviewing medical and surgical options and prophylactic antibiotic therapy.

A Comparative Look at Pet Food Formats: Making Informed Choices for Our Pets

This presentation explores the evolving landscape of pet food formats, comparing the nutritional profiles and impacts of dry kibble, wet food, treats, supplements, and fresh food. Nolan Frantz, PhD, MS, a leading expert in companion animal nutrition with extensive industry experience, presents data from 2 original studies comparing extruded kibble with fresh and human-grade diets in beagles. These studies investigated the effects of different food formats on fecal characteristics, microbiome composition, serum profiles, hematology, gene expression, and skin/coat health. Additionally, the presentation discusses the pros and cons of each pet food format, considering factors such as cost, convenience, palatability, nutritional content, and long-term health implications. Further research is needed to fully understand the long-term effects of different pet food formats on canine health and to identify the key drivers of any health implications. The presentation concludes with a discussion of the significant growth of the pet food industry and the increasing consumer demand for fresh and human-grade options.

Canine Lymphoma Treatment—Never a One Size Fits All

: Craig A. Clifford, DVM, MS, DACVIM (Oncology)

This 1-hour virtual webinar discusses how Laverdia CA-1 (verdinexor tabs) fits into the treatment of dogs with lymphoma. We dive into the mechanism of action, dosing, adverse events, and efficacy of this novel agent. Finally, we talk about why Laverdia CA-1 should be used in primary care.

Check out these continuing education opportunities now available.

Flex Forecast: Top CE opportunities of 2025

At the 2025 New York Vet Show in New York, New York, Michael Lappin, DVM, PhD, DACVIM (SAIM), a professor of infectious disease in the Department of Clinical Sciences at Colorado State University in Fort Collins, led a lecture on the management of chronic gastrointestinal (GI) disease in cats presenting with vomiting and/or diarrhea.

 The session covered a range of primary and secondary GI diseases, including 

has zoonotic potential, approximately 85% of feline 

 infections do not infect humans, Lappin explained.

 Meanwhile, the remaining 15% comprise the 

assemblages A and B, which are the genetic assemblages that are zoonotic.

During the lecture, Lappin reminded attendees that combining a fecal float—ideally using zinc sulfate or a sugar solution—with a 

antigen test provides a 97% sensitivity. If both tests are negative, the likelihood that the patient has Giardia is only approximately 3%. This combined testing approach makes repeat testing unnecessary, thereby reducing diagnostic costs for clients.

According to the World Small Animal Veterinary Association, Lappin emphasized, cats or dogs with normal stools do not need to be treated for 

 “I want to make sure you know that you do not need to treat any 

-positive animal if they have a normal stool,” he said.

 “All you are doing [with this] is selecting for resistance strains. By testing healthy [patients] and then retesting them, we're wasting [client] money and selecting for resistance.”

Michael Lappin, DVM, PhD, DACVIM (SAIM) lecturing at the NY Vet Show. 

Patients with recurring diarrhea should be treated, but cats with a consistent score of 2 or 3 on the Purina Fecal Scoring Chart do not need treatment, Lappin continued, adding that the parasite has the capacity to reinfect cats within 9 days.

, Lappin explained that metronidazole is hard on the microbiome, so fenbendazole should be used as a first treatment of giardiasis. For resistant cases, metronidazole can be used; however, Lappin strongly recommends giving probiotics to patients on metronidazole, as the drug may induce GI dysbiosis. An older study also found that fiber can inhibit 

adherence, with animals on a low-fiber diet being significantly more likely to become infected after being inoculated with 100 

lamblia cysts compared with those fed a high-fiber diet.

According to Lappin, psyllium, a soluble fiber, can lessen 

adherence. “FortiFlora PRO [Synbiotic Action Feline Health Supplement], which has psyllium, is a great choice, because you've got your probiotic and your psyllium,” he said.

Lappin advised switching the patient to metronidazole if the diarrhea is still present after 5 days of fenbendazole. If the diarrhea is still present after another 5 days, Lappin stressed that the patient most likely has another issue.

“You never need more than 2 drugs—one from each class,” Lappin said, emphasizing that his 30 years of experience as a 

 researcher have shown that if a patient fails to respond to 2 drugs combined with a high-fiber, probiotic, and low-fat diet, they most likely have a coinfection or another GI disease. “I call it, '2 drugs, and you're out in my 3 strikes.'”

Lappin M. Update on the management of chronic GI disease in cats. Presented at: 2025 New York Vet Show; November 6-7, 2025; New York, NY.

Leitch GJ, Visvesvara GS, Wahlquist SP, Harmon CT. Dietary fiber and giardiasis: dietary fiber reduces rate of intestinal infection by Giardia lamblia in the gerbil. 

. 1989;41(5):512-520. doi:10.4269/ajtmh.1989.41.512

Not all cats need to be treated for giardiasis, Michael Lappin, DVM, PhD, DACVIM, explained in a lecture at the 2025 New York Vet Show.

Treating Giardia in cats

In this interview, Galina Hayes, BVSc, DVSc, PhD, DACVECC, DACVS, an associate professor at Cornell University, shares how surgeons can optimize intestinal healing. 

Blood flow: The biggest factor in GI surgery recovery

In this interview highlighting her session on gastrointestinal (GI) surgery tips presented at the 2025 New York Vet Show in New York, New York, Galina Hayes, BVSc, DVSc, PhD, DACVECC, DACVS, an associate professor at Cornell University College of Veterinary Medicine in Ithaca, New York, discusses one of the most important physiologic factors that influence how a patient’s intestine heals after a surgical procedure: perfusion to the intestine. She shares ways surgeons can optimize blood flow, from carefully handling bowel margins and maintaining proper suture tension to supporting the patient’s systemic health.

Hi, my name is Galina Hayes. I'm a specialty soft tissue surgeon here at Cornell University in Ithaca...New York. I've been teaching veterinary surgery for the [past] 12 to 13 years. I'm also boarded in emergency and critical care, which I find really helpful for preoperative and postoperative management of our trickier patients. Before I became a specialist, I worked in [emergency department] practice, and before that, in small animal and mixed practice....

What are some key physiologic factors that influence how the intestine heals after surgery?

The big one is blood flow, so perfusion to the intestine. As surgeons, we can optimize healing with careful handling of the [bowel] margins...when we're suturing, either for an enterotomy or an anastomosis, to minimize congestion and inflammation and [to] keep blood flow brisk and healthy to those wound edges. Also, [we should be] controlling our suture tension so we don't inadvertently compromise blood flow with overtight sutures—just getting really nice apposition there.

Blood flow is probably one of the biggest things. We can think about it at a microlevel with the examples I just talked about, with blood flow at the wound edges. But of course, that's also dependent on the [patient's] systemic health.... Ideally, they're well hydrated, they've been fluid resuscitated if needed before surgery, and we're controlling depth of anesthesia to keep blood pressure in a nice, healthy, optimal zone. All those things in concert help us get the outcomes we're after.

Galina Hayes, BVSc, DVSc, PhD, DACVECC, DACVS, talks about the biggest physiologic factor that influences how the intestine heals after surgery in this dvm360 interview.

Optimizing blood flow to improve GI surgery healing

In this live Vet Blast Podcast recording from Fetch National Harbor, Matt Bubala interviews our regular host Adam Christman, DVM, MBA,  to talk about the complexities of canine atopic dermatitis

A multimodal approach to canine dermatology

, presented by dvm360 and recorded live on site at Fetch National Harbor, the tables have turned, and our regular host, Adam Christman, DVM, MBA, is the guest! 

Join Christman and interim host Matt Bubala, president at Black Dog Productions, Inc., as they explore the spectrum of care for the chronically itchy dog. Throughout the show, Christman and Bubala discuss why the management of atopic dermatitis is layered and complex, highlighting the many tools now available to veterinary professionals. Listeners will learn about the importance of the initial dermatologic database, how to leverage new pharmacological options, and the emerging research on the gut-skin axis in promoting skin health.

Below is a partial transcript, edited lightly for clarity. 

There are so many tools in your toolbox these days. Is it that we hear the term 

 [and wonder] how to tackle an itchy pet when they come into practice?

Yes. The first thing is that you want to identify and ditch the itch. The best thing, which we always do, is monitor your full dermatologic database. You really don't want to miss those easy things. Flea comb, skin cytology, impression cytology, ear cytology—all of that's part of your dermatologic database. And, of course, shining the black light on them, too, just to make sure you're not dealing with any ringworm.

I think those are the basic things. What we're finding, [and] what I'm seeing around practices, is that they're charging a dermatology database code. So instead of them being priced out for your cytology times, skin cytology times,  you just include one cost, whatever that might be. So that way, you can allocate that into more of the products or services or prescriptions that are going to go out there, because it can add up.

You're looking at topicals, you're looking at controlling the itch, and maybe antibiotics or antifungals, all in one.

When [an itchy pet] comes in your practice, what is step one for you? Because there are so many options. Are you trying to eliminate certain things? Are you trying to tackle it all at once? I imagine the first thing you're saying is, I've got to stop the itch. This pet is suffering, and so are the owners.

 It really is to your point that it's a collaborative effort of realizing and setting expectations, especially if we have an atopic dog, which is a diagnosis of exclusion, as we all know. But we have to [explain] that expectation to the pet owner, [to say], listen, this isn't treatable, it's manageable. And those are such key words. And talking to them about that.

Podcasts

Explore effective strategies for managing itchy pets with Adam Christman, DVM, MBA, and Matt Bubala.