October 17, 2025 • 18 mins
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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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:00):
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SPEAKER_01 (00:35):
Welcome to Veterinary Vertex, the Avium Aid
Journal's podcast, where wedelve into the behind-the-scenes
look with manuscript authors.
I'm editor-in-chief LisaFortier, joined by Associate
Editor Sarah Wright.
Today we're discussing a studythat compares clinical early
incisional healing outcomes ofTPLO incision closures when
using reverse cutting or taperpoint needles for intradermal
(00:58):
closure with the author of thatmanuscript, Josh Becker.
Hey Josh, thanks for taking timeout of your super busy schedule
to be with us here today.
SPEAKER_03 (01:07):
Yeah, absolutely.
Thank you for having me.
SPEAKER_02 (01:09):
So, Josh, before we dive in, can you share a little
bit about your background andwhat brought you to suture
needle selection research?
SPEAKER_03 (01:15):
Yeah.
So as far as my researchbackground goes, it kind of
started in undergrad where I wasfirst exposed to the ins and
outs of research, like a wholeresearch process.
Um in bed school, I helped uhwith some clinical research for
a surgeon, uh, mostly just likedata gathering and organizing um
at school.
And then um I also helped withsome animal ethics publications
(01:36):
um with a law school professorwho also happened to lecture on
animal ethics to the beststudents and veterinarians.
Um I co-authored a book chapteron um single port uh minimally
invasive techniques with one ofmy mentors during my surgical
internship.
And I've had a lot of uh funfact, I still can't spell uh
laparoscopic correctly, likehalf the time.
(01:58):
But um I also participated in afew other projects and failed
more times than I'd care toadmit in trying to get some
projects off the ground.
Um, but uh it's all kind of ledup to just um a fair amount of
exposure to research.
Um I just finished up mysurgical residency.
Um, so uh research is somethingI've always kind of been
(02:20):
interested in and hope tocontinue well beyond residency.
And uh yeah, uh what how thatbrought me to suture needle
selection um was because um it'sone something that's um been
overlooked in the vetliterature, and two, when coming
from a busy um private practicesetting, um, it was a accessible
(02:42):
topic for me to really look intowithout having to necessarily
have all the fancy equipment andspecialized tools that you might
get in an academic setting orlike a highly specialized
setting.
So it was something that like Icould potentially get good data
on um and publish on while notnecessarily having you know all
the cool bits to really get morefacts.
SPEAKER_01 (03:06):
Yeah, very clinically applicable.
It's the first thing I askpeople when they say, Oh, could
you help me design a researchproject?
What is your interest?
And then they say what theirinterest is.
I'm like, do you have the casenumber to support that?
So well done to identify that.
It sounds like you got goodmentoring early on.
SPEAKER_03 (03:21):
Yeah, I was very lucky in that regard.
So um hopefully I haven'tembarrassed them with this
paper.
SPEAKER_01 (03:27):
I think you probably found that luck.
Uh, your this jab article uhdiscusses how taper needles are
non-inferior to reverse cuttingneedles for intradermal closure
for TPLO.
Uh, I'm a surgeon too, and Iknow that these needles are for
especially for intradermalpeople, have strong opinions, so
shall we say?
(03:47):
And I guess for me, I would havethought the difference between
these was due to skin thickness,skin toughness.
But uh, what was your motivationfor this research?
SPEAKER_03 (03:57):
Um, really the lack of uh like empirical data out
there in the vet literature andeven in the human literature,
it's uh also kind of debated,you know.
Like you said, during mytraining, I had some mentors who
had very strong opinions on theneedle I ought to be using.
Um, but then because they hadsuch strong opinions, it it made
me go, like, okay, well, where'syour proof?
So I'd look it up and be like,oh, here's some papers that say
(04:19):
this and other papers that saythat.
But the more and more you lookinto it, there's there's no one
that actually has anything to belike, 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 toactually pin something down
here.
SPEAKER_01 (04:38):
Yeah, I like it.
You already said one of thefactors when considering the
design was that you had anadequate case number to support
or refute your hypothesis.
And then the next thing would beyour outcome measures.
How did you define and measurenon-inferiority in this context?
SPEAKER_03 (04:54):
Yeah, um, frankly, I think the use of the term
non-inferiority from like astatistical standpoint is
probably a bit of a misnomer.
But um the problem was that foruh non-inferiority studies, we
need that like non-inferioritymargin to define, like, oh, you
know, deviation this much fromthe outcome is what you can call
like inferiority inferior or notinferior.
(05:14):
But because we didn't have anestablished um, you know, this
is the correct needle, this isthe standard.
Um it was more of a even if wefound something um like we did
in the paper, it was like, youknow, there's evidence to show
there might be a difference, wecouldn't be like, hey, this is
something we should look intofurther, not necessarily like
this is the better needle.
(05:35):
Um so really it was more like uhlook, there's especially in this
paper, there was no differencein clinical outcomes, but we did
find some statistical differencein the you know 18 to 24 hour
post uh incision check.
Um, so that if we use the termnon-inferiority, there's
(05:56):
probably uh in hindsight abetter way to state it, but um,
for the sake of brevity for thetitle, and honestly, just for
the lack of my ability to figureout a better term, I went with
non-inferiority.
SPEAKER_01 (06:09):
So which needle does Josh Becker use?
SPEAKER_03 (06:12):
Um I do like the taper needle, at least with my
TPLOs.
Uh in the paper, you know, I domention that it is probably
different for different parts ofthe body.
I mean, for an intact male, umlike an abdominal closure, I'm
going with the cutting.
Yeah.
Um, because I've definitely bentenough of those turn surgeries
to be like, all right, nope, notworking.
(06:33):
Um, but here for TPLOs, yeah.
Personally, I I've done enoughTPLO engineer closures at this
point where I'm like, yeah,let's go taper.
SPEAKER_02 (06:41):
Yeah, makes sense.
Yeah, this research is movingthe needle, no pun intended.
That's terrible.
I know.
I've been thinking about thatfor like the last five minutes.
SPEAKER_01 (06:54):
Bad joke from here, I Lisa.
Only from a non-surgeon woulduse that.
SPEAKER_02 (06:59):
Definitely non-surgeon over here.
So, Josh, what are some of thekey take-home messages you hope
veterinarians will remember fromthis work?
SPEAKER_03 (07:09):
I mean, realistically, again, we can't
say like this is the betterneedle.
It's really our final suggeststhat the taper needle may have a
benefit in the context of TPLintradermal closures.
You know, that's a very narrowlydefined uh window.
But um, I think what may becross-applicable,
cross-applicable here is that uhthinking about all the little
(07:29):
steps that you take in anysurgery, every every tool, every
technique, um, everything we do,really you need to think about
it because it could have adifference in patient outcome.
So being able to tailor that toevery patient, every situation
will make you a better surgeon.
SPEAKER_02 (07:44):
Yeah, like that's how you come up being
intentional with your choices.
I think that's important.
SPEAKER_03 (07:48):
Yeah.
SPEAKER_02 (07:49):
And how can veterinarians integrate these
insights into their dailyclinical routines?
SPEAKER_03 (07:54):
Kind of going into that same thought process, it's
just mindfulness.
Um, doesn't necessarily evenneed to be in surgery.
Just again, always having arationale and ideally some
empirically driven data that caninform your decisions and your
decision making.
SPEAKER_01 (08:09):
Okay, Josh, what's one lesson in life doesn't have
to necessarily be in the OR thatyou learn the hard way, and how
would you pass that on tosurgeons?
Again, it doesn't have to besurgical, it can be how to
navigate a career, any anythinglike that.
SPEAKER_03 (08:23):
Honestly, it's easy for me to pick a surgical one
because surgery is fickle,particularly soft tissue.
Um, you know, orthopedics, youhave that uh you've you usually
know you've done it right oryou've done it wrong pretty,
pretty immediately, which isvery gratifying.
But with soft tissue, you'd belike, oh, that was the best one
I've ever done, and then itblows up in your face, and
you're just like, oh God, whathave I done wrong?
You're ripping out your hair,just thinking of all the things
(08:43):
you could have done better, orlooking back, you know, what
what did I miss?
Um, so I guess that that onelesson would just be like don't
be too hard on yourself, but uhmake sure you're thinking about
everything.
And really when those things dohappen, you gotta do a good uh
workup afterward to figure outwhy.
SPEAKER_01 (09:02):
Yeah, I like that.
With my veterinary students andand my residents, when we were
scrubbing, I would say, what didwe do well last time on this
surgery?
What could we do better?
And then when we're de-gowninguh 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?
(09:24):
You know, we didn't havesomething prepared, uh, we
didn't prepare with a technicalteam well enough.
Uh, so I think being mindful andreflective, but don't again
don't be too hard on yourself.
SPEAKER_03 (09:35):
Yeah.
Yeah, there's I I'd never doneor seen a perfect surgery.
There's always something thatcould be better.
So that's a good takeaway forthat.
SPEAKER_01 (09:44):
Yeah, that is true.
For veterinary studentsconsidering a surgical path,
what advice would you give tothem?
SPEAKER_03 (09:49):
Uh work hard, study, be a good student your whole
career, and just love what youdo.
You know, if you're pickingsurgery, you should pick it
because it's the coolest thingin the world.
SPEAKER_01 (09:58):
It is.
Yep.
SPEAKER_03 (10:01):
Sorry, Sarah.
SPEAKER_02 (10:02):
No, it's okay.
I was gonna say spoken againlike true surgeons.
So looking ahead, what are thenext steps for research in this
area?
SPEAKER_03 (10:10):
Well, since we did find, you know, some
statistically significant data,I think really it's just being
able to verify or disprove it atthis point.
Um, we touched upon it a littlein the paper, but um we should
be thinking about how to findmore objective ways to evaluate
the differences and verify thatthey exist or don't.
And then what are the clinicalimplications of that?
So um, you know, like I wassaying, does it apply to
(10:32):
different areas of the body forthe differences we do find?
Um, what does that mean for thepatient and their outcomes?
And really, how can we continueto build on that and apply it to
better serve our patients?
SPEAKER_02 (10:42):
And are there any gaps or limitations in current
knowledge that you think shouldbe addressed first?
SPEAKER_03 (10:47):
Yeah, a big one would be like particularly for
my study, what I found was thatthere's no objective metric in
vetmed for wound assessment,like for incision healing.
Um, there's a couple smallerstudies.
I referenced a few that um, youknow, they they came up with um,
you know, quantitative orsemi-quantitative methods to try
to objectively evaluate that.
(11:09):
But um, there's nothing that'sbeen value validated in vetmed,
like we have you know, theanimal trauma triage score, the
glass-cauicoma scale, all ofwhich have you know further
studies to be like, look, thisworks and is accurate.
We don't have that in uh youknow on our side of the fence.
Human medicine has a uh at leastone.
I I tried to rip as much fromthat as possible, but um, it's
(11:29):
just not as cross-applicable toveterinary patients because
you're not asking them, oh, doyou smoke?
Like, um, so there's there'sless I can use for that.
And so I think that would be a agreat uh line of research for
someone to really figure out andgive us that tool.
SPEAKER_02 (11:45):
Maybe that someone can be you, Josh.
SPEAKER_03 (11:47):
Maybe I like my the the incision scoring system I
came up with, but um again, Iwould like some validation.
And one idea um that was tossedout that would have been really
cool is maybe something AIdriven or just uh computer
driven based on the photos wetook.
And you know, you you quantifythe length of the incision, you
have it uh um standardized tothe length, and then you can get
(12:12):
like an area that's affected bylike erythema, bruising, um
something like that, and you canget actual percentages.
But again, then the the sameproblem you got to validate it
and all that.
So someone smarter than me withelectronics might be able to
figure that out.
SPEAKER_01 (12:25):
But that would be super helpful too for
postoperative care, icing, heat,mobilization, all of those
things that we do and don'treally know how much, even if
it's increased vascularity ordecreased, how does that affect
wound healing?
And Josh, you talked about uhthe great exposure you had in
undergrad and then as aresident.
How did this training uh uhculminate and prepare you to
(12:51):
write this article?
SPEAKER_03 (12:52):
Uh, I think really the biggest thing it did was
really help me troubleshoot allof the robots we kind of
encountered during the process.
Um, you know, there's a lot ofthings that's from a third-party
perspective when you're watchinga study be conducted that you're
not thinking about.
And when you're actually doingit, you're just like, there's so
many, and you you realize howmany intangibles you you come up
(13:13):
against, just like trying to getthe clinic flow, trying to make
sure that um, you know, uhyou're you're gathering the data
appropriately, that the patientsare being handled appropriately,
the clients are being handledappropriately, you know, you're
you're crossing your T's,dotting your I's and um yeah,
that was as frustrating as itwas fun.
SPEAKER_01 (13:33):
There is a lot to it that people don't understand
when they're just reading thearticle.
SPEAKER_03 (13:37):
Yeah, yeah, and and you realize too, like how
fragile and how valuable thatobjective data is when you start
to realize all the things youcould do to screw it up.
SPEAKER_01 (13:48):
But you didn't.
SPEAKER_03 (13:49):
No, no, I worked very hard not to.
SPEAKER_01 (13:52):
So did all of this background give you a unique
lens or a bias and that shapedhow you interpreted the data?
Or even acquired it or designedthe study?
SPEAKER_03 (14:01):
Honestly, I I did come in with a huge bias in
terms of my preference forneedle, at least in TPLs,
because I uh I felt anecdotallyI thought I saw a lot more
immediate post-ile bruising fromthe cutting needle.
Um, so I had to really work hardto make sure that all the
throughout the whole process, Iwas as blinded as possible to
the uh I was blinded to theneedle type when I was gathering
(14:23):
my data.
Um and it was surprising findingthat, you know, oh I that
anecdotal feeling.
I was like, oh yeah, we'redefinitely gonna have more
bruising from the the cuttingneedles.
Watch this.
And then it was like, oh, therewas 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 (14:44):
It's always cool to see what the evidence shows us.
SPEAKER_03 (14:47):
Yeah.
SPEAKER_02 (14:48):
So, Josh, this next set of questions is gonna be
really important for ourlisteners.
These are our big take-homes.
The first one's gonna be aboutthe veterinarian's perspective.
So, what is one piece ofinformation the veterinarian
should know about using reversecutting or taper point needles
for intradermal closure duringTPLOs?
SPEAKER_03 (15:05):
They both work.
Um, you know, our our ouroutcomes um for the patients
were good either way.
We didn't have any significantdifferences in the complication
rates.
Um, you know, the nice thingabout TPLOs, especially in this
population where we really triedto eliminate any confounding
factors from like comorbidities,is TPLO patients are usually
healthy, happy, young tomiddle-aged, you know, dogs that
(15:27):
want to go back to ripping andtearing on the ground.
So um, if there's a particularneedle that a primary care
veterinarian or surgeon feelsthat they have a better outcome
with on their TPLO introdumclosures, go for it.
SPEAKER_02 (15:40):
Um said.
And for the clients, what's onething you wish more people
understood about this topic?
SPEAKER_03 (15:48):
It's not black or white.
Um, you know, there's a lot ofthings in science and medicine
where they're it's easy to forman opinion because of Dr.
Google.
But um, understanding there's alot of clinical discretion and
getting objective data is ishard.
SPEAKER_01 (16:02):
Thank you, Josh, for being with us.
As we wrap up, we like to have alittle bit of fun with a few
questions.
Uh so what is your favoriteanimal fact?
You know, that fact that you digout when conversation's a little
bit at a lull and people arelike, no, I didn't know that.
SPEAKER_03 (16:16):
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-seaanglerfish are probably one of
the more extreme examples ofsexual dimorphism in animals and
have a very unique strategy tomating, which has been termed
(16:39):
sexual parasitism.
Um, so the male anglerfish issignificantly smaller than the
female.
They have uh there's certainspecies that are literally
unable to eat because they don'thave an appropriately um formed
digestive system.
Um it's completelyunderdeveloped, and basically uh
they're just swimming bags ofgametes whose only purpose in
(17:00):
life is to find a female, latchon, um, and at which point they
become embedded to the femalepermanently, um, where they'll
even start to share a bloodsystem, uh, blood supply uh and
are functionally just uh a setof gametes that they can use
when appropriate.
SPEAKER_01 (17:21):
A sweep meet set of gametes.
That's awesome.
All right, well, uh let's seewhat you have for this one then.
What do you think is the mostbeautiful animal?
SPEAKER_03 (17:30):
Look up the greater Po-2.
That one just makes me laugh.
SPEAKER_01 (17:34):
Tell us what I don't know what that is.
SPEAKER_03 (17:36):
Uh the Greater Potu is one of the more it's uh
common burden um South America.
Uh really interesting lookinganimal, but um, I think they're
gorgeous.
SPEAKER_01 (17:46):
So why?
Why do you think it's sobeautiful?
SPEAKER_03 (17:49):
Um makes me laugh.
SPEAKER_02 (17:53):
Okay, that's fair.
SPEAKER_03 (17:54):
Functional makes me laugh.
SPEAKER_02 (17:56):
Definitely gonna look that up after this.
Can you spell it?
I'm Richard, look it up.
SPEAKER_03 (17:59):
E-O-T-O-O.
SPEAKER_02 (18:00):
Okay, perfect.
Thank you.
Even the name is funny.
Awesome.
Well, thank you so much, Josh.
We appreciate you being herewith us today and also for
sharing your words too withJavma.
SPEAKER_03 (18:10):
Yeah, thank you so much for having me.
Um, and hopefully I can getanother paper or two through you
guys uh in the future.
SPEAKER_02 (18:16):
Awesome.
We'll be looking forward to itfor sure.
And for our listeners, you canread Josh's full article on
Javma.
I'm Sarah Wright here with LisaFortier.
Be sure to tune in next week foranother episode of Veterinary
Vertex.
And don't forget to leave us arating and review on Apple
Podcasts or wherever you listen.
From the makers of FET recommended Green East
(00:02):
Dental Treats, comes an easy wayto support your dog's wellness.
Green East Smart Essentials DryFood delivers complete balanced
nutrition with science-backedrecipes.
Green East Supplements,developed by a team of PhD
animal nutritionists, offersoptions to help support healthy
joints, digestion, and more.
(00:24):
Whether it's meal time ormobility support, Green East
helps you care for your dog fromthe inside out.
Learn more at Greenece.com.
SPEAKER_01 (00:35):
Welcome to Veterinary Vertex, the Avium Aid
Journal's podcast, where wedelve into the behind-the-scenes
look with manuscript authors.
I'm editor-in-chief LisaFortier, joined by Associate
Editor Sarah Wright.
Today we're discussing a studythat compares clinical early
incisional healing outcomes ofTPLO incision closures when
using reverse cutting or taperpoint needles for intradermal
(00:58):
closure with the author of thatmanuscript, Josh Becker.
Hey Josh, thanks for taking timeout of your super busy schedule
to be with us here today.
SPEAKER_03 (01:07):
Yeah, absolutely.
Thank you for having me.
SPEAKER_02 (01:09):
So, Josh, before we dive in, can you share a little
bit about your background andwhat brought you to suture
needle selection research?
SPEAKER_03 (01:15):
Yeah.
So as far as my researchbackground goes, it kind of
started in undergrad where I wasfirst exposed to the ins and
outs of research, like a wholeresearch process.
Um in bed school, I helped uhwith some clinical research for
a surgeon, uh, mostly just likedata gathering and organizing um
at school.
And then um I also helped withsome animal ethics publications
(01:36):
um with a law school professorwho also happened to lecture on
animal ethics to the beststudents and veterinarians.
Um I co-authored a book chapteron um single port uh minimally
invasive techniques with one ofmy mentors during my surgical
internship.
And I've had a lot of uh funfact, I still can't spell uh
laparoscopic correctly, likehalf the time.
(01:58):
But um I also participated in afew other projects and failed
more times than I'd care toadmit in trying to get some
projects off the ground.
Um, but uh it's all kind of ledup to just um a fair amount of
exposure to research.
Um I just finished up mysurgical residency.
Um, so uh research is somethingI've always kind of been
(02:20):
interested in and hope tocontinue well beyond residency.
And uh yeah, uh what how thatbrought me to suture needle
selection um was because um it'sone something that's um been
overlooked in the vetliterature, and two, when coming
from a busy um private practicesetting, um, it was a accessible
(02:42):
topic for me to really look intowithout having to necessarily
have all the fancy equipment andspecialized tools that you might
get in an academic setting orlike a highly specialized
setting.
So it was something that like Icould potentially get good data
on um and publish on while notnecessarily having you know all
the cool bits to really get morefacts.
SPEAKER_01 (03:06):
Yeah, very clinically applicable.
It's the first thing I askpeople when they say, Oh, could
you help me design a researchproject?
What is your interest?
And then they say what theirinterest is.
I'm like, do you have the casenumber to support that?
So well done to identify that.
It sounds like you got goodmentoring early on.
SPEAKER_03 (03:21):
Yeah, I was very lucky in that regard.
So um hopefully I haven'tembarrassed them with this
paper.
SPEAKER_01 (03:27):
I think you probably found that luck.
Uh, your this jab article uhdiscusses how taper needles are
non-inferior to reverse cuttingneedles for intradermal closure
for TPLO.
Uh, I'm a surgeon too, and Iknow that these needles are for
especially for intradermalpeople, have strong opinions, so
shall we say?
(03:47):
And I guess for me, I would havethought the difference between
these was due to skin thickness,skin toughness.
But uh, what was your motivationfor this research?
SPEAKER_03 (03:57):
Um, really the lack of uh like empirical data out
there in the vet literature andeven in the human literature,
it's uh also kind of debated,you know.
Like you said, during mytraining, I had some mentors who
had very strong opinions on theneedle I ought to be using.
Um, but then because they hadsuch strong opinions, it it made
me go, like, okay, well, where'syour proof?
So I'd look it up and be like,oh, here's some papers that say
(04:19):
this and other papers that saythat.
But the more and more you lookinto it, there's there's no one
that actually has anything to belike, 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 toactually pin something down
here.
SPEAKER_01 (04:38):
Yeah, I like it.
You already said one of thefactors when considering the
design was that you had anadequate case number to support
or refute your hypothesis.
And then the next thing would beyour outcome measures.
How did you define and measurenon-inferiority in this context?
SPEAKER_03 (04:54):
Yeah, um, frankly, I think the use of the term
non-inferiority from like astatistical standpoint is
probably a bit of a misnomer.
But um the problem was that foruh non-inferiority studies, we
need that like non-inferioritymargin to define, like, oh, you
know, deviation this much fromthe outcome is what you can call
like inferiority inferior or notinferior.
(05:14):
But because we didn't have anestablished um, you know, this
is the correct needle, this isthe standard.
Um it was more of a even if wefound something um like we did
in the paper, it was like, youknow, there's evidence to show
there might be a difference, wecouldn't be like, hey, this is
something we should look intofurther, not necessarily like
this is the better needle.
(05:35):
Um so really it was more like uhlook, there's especially in this
paper, there was no differencein clinical outcomes, but we did
find some statistical differencein the you know 18 to 24 hour
post uh incision check.
Um, so that if we use the termnon-inferiority, there's
(05:56):
probably uh in hindsight abetter way to state it, but um,
for the sake of brevity for thetitle, and honestly, just for
the lack of my ability to figureout a better term, I went with
non-inferiority.
SPEAKER_01 (06:09):
So which needle does Josh Becker use?
SPEAKER_03 (06:12):
Um I do like the taper needle, at least with my
TPLOs.
Uh in the paper, you know, I domention that it is probably
different for different parts ofthe body.
I mean, for an intact male, umlike an abdominal closure, I'm
going with the cutting.
Yeah.
Um, because I've definitely bentenough of those turn surgeries
to be like, all right, nope, notworking.
(06:33):
Um, but here for TPLOs, yeah.
Personally, I I've done enoughTPLO engineer closures at this
point where I'm like, yeah,let's go taper.
SPEAKER_02 (06:41):
Yeah, makes sense.
Yeah, this research is movingthe needle, no pun intended.
That's terrible.
I know.
I've been thinking about thatfor like the last five minutes.
SPEAKER_01 (06:54):
Bad joke from here, I Lisa.
Only from a non-surgeon woulduse that.
SPEAKER_02 (06:59):
Definitely non-surgeon over here.
So, Josh, what are some of thekey take-home messages you hope
veterinarians will remember fromthis work?
SPEAKER_03 (07:09):
I mean, realistically, again, we can't
say like this is the betterneedle.
It's really our final suggeststhat the taper needle may have a
benefit in the context of TPLintradermal closures.
You know, that's a very narrowlydefined uh window.
But um, I think what may becross-applicable,
cross-applicable here is that uhthinking about all the little
(07:29):
steps that you take in anysurgery, every every tool, every
technique, um, everything we do,really you need to think about
it because it could have adifference in patient outcome.
So being able to tailor that toevery patient, every situation
will make you a better surgeon.
SPEAKER_02 (07:44):
Yeah, like that's how you come up being
intentional with your choices.
I think that's important.
SPEAKER_03 (07:48):
Yeah.
SPEAKER_02 (07:49):
And how can veterinarians integrate these
insights into their dailyclinical routines?
SPEAKER_03 (07:54):
Kind of going into that same thought process, it's
just mindfulness.
Um, doesn't necessarily evenneed to be in surgery.
Just again, always having arationale and ideally some
empirically driven data that caninform your decisions and your
decision making.
SPEAKER_01 (08:09):
Okay, Josh, what's one lesson in life doesn't have
to necessarily be in the OR thatyou learn the hard way, and how
would you pass that on tosurgeons?
Again, it doesn't have to besurgical, it can be how to
navigate a career, any anythinglike that.
SPEAKER_03 (08:23):
Honestly, it's easy for me to pick a surgical one
because surgery is fickle,particularly soft tissue.
Um, you know, orthopedics, youhave that uh you've you usually
know you've done it right oryou've done it wrong pretty,
pretty immediately, which isvery gratifying.
But with soft tissue, you'd belike, oh, that was the best one
I've ever done, and then itblows up in your face, and
you're just like, oh God, whathave I done wrong?
You're ripping out your hair,just thinking of all the things
(08:43):
you could have done better, orlooking back, you know, what
what did I miss?
Um, so I guess that that onelesson would just be like don't
be too hard on yourself, but uhmake sure you're thinking about
everything.
And really when those things dohappen, you gotta do a good uh
workup afterward to figure outwhy.
SPEAKER_01 (09:02):
Yeah, I like that.
With my veterinary students andand my residents, when we were
scrubbing, I would say, what didwe do well last time on this
surgery?
What could we do better?
And then when we're de-gowninguh 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?
(09:24):
You know, we didn't havesomething prepared, uh, we
didn't prepare with a technicalteam well enough.
Uh, so I think being mindful andreflective, but don't again
don't be too hard on yourself.
SPEAKER_03 (09:35):
Yeah.
Yeah, there's I I'd never doneor seen a perfect surgery.
There's always something thatcould be better.
So that's a good takeaway forthat.
SPEAKER_01 (09:44):
Yeah, that is true.
For veterinary studentsconsidering a surgical path,
what advice would you give tothem?
SPEAKER_03 (09:49):
Uh work hard, study, be a good student your whole
career, and just love what youdo.
You know, if you're pickingsurgery, you should pick it
because it's the coolest thingin the world.
SPEAKER_01 (09:58):
It is.
Yep.
SPEAKER_03 (10:01):
Sorry, Sarah.
SPEAKER_02 (10:02):
No, it's okay.
I was gonna say spoken againlike true surgeons.
So looking ahead, what are thenext steps for research in this
area?
SPEAKER_03 (10:10):
Well, since we did find, you know, some
statistically significant data,I think really it's just being
able to verify or disprove it atthis point.
Um, we touched upon it a littlein the paper, but um we should
be thinking about how to findmore objective ways to evaluate
the differences and verify thatthey exist or don't.
And then what are the clinicalimplications of that?
So um, you know, like I wassaying, does it apply to
(10:32):
different areas of the body forthe differences we do find?
Um, what does that mean for thepatient and their outcomes?
And really, how can we continueto build on that and apply it to
better serve our patients?
SPEAKER_02 (10:42):
And are there any gaps or limitations in current
knowledge that you think shouldbe addressed first?
SPEAKER_03 (10:47):
Yeah, a big one would be like particularly for
my study, what I found was thatthere's no objective metric in
vetmed for wound assessment,like for incision healing.
Um, there's a couple smallerstudies.
I referenced a few that um, youknow, they they came up with um,
you know, quantitative orsemi-quantitative methods to try
to objectively evaluate that.
(11:09):
But um, there's nothing that'sbeen value validated in vetmed,
like we have you know, theanimal trauma triage score, the
glass-cauicoma scale, all ofwhich have you know further
studies to be like, look, thisworks and is accurate.
We don't have that in uh youknow on our side of the fence.
Human medicine has a uh at leastone.
I I tried to rip as much fromthat as possible, but um, it's
(11:29):
just not as cross-applicable toveterinary patients because
you're not asking them, oh, doyou smoke?
Like, um, so there's there'sless I can use for that.
And so I think that would be a agreat uh line of research for
someone to really figure out andgive us that tool.
SPEAKER_02 (11:45):
Maybe that someone can be you, Josh.
SPEAKER_03 (11:47):
Maybe I like my the the incision scoring system I
came up with, but um again, Iwould like some validation.
And one idea um that was tossedout that would have been really
cool is maybe something AIdriven or just uh computer
driven based on the photos wetook.
And you know, you you quantifythe length of the incision, you
have it uh um standardized tothe length, and then you can get
(12:12):
like an area that's affected bylike erythema, bruising, um
something like that, and you canget actual percentages.
But again, then the the sameproblem you got to validate it
and all that.
So someone smarter than me withelectronics might be able to
figure that out.
SPEAKER_01 (12:25):
But that would be super helpful too for
postoperative care, icing, heat,mobilization, all of those
things that we do and don'treally know how much, even if
it's increased vascularity ordecreased, how does that affect
wound healing?
And Josh, you talked about uhthe great exposure you had in
undergrad and then as aresident.
How did this training uh uhculminate and prepare you to
(12:51):
write this article?
SPEAKER_03 (12:52):
Uh, I think really the biggest thing it did was
really help me troubleshoot allof the robots we kind of
encountered during the process.
Um, you know, there's a lot ofthings that's from a third-party
perspective when you're watchinga study be conducted that you're
not thinking about.
And when you're actually doingit, you're just like, there's so
many, and you you realize howmany intangibles you you come up
(13:13):
against, just like trying to getthe clinic flow, trying to make
sure that um, you know, uhyou're you're gathering the data
appropriately, that the patientsare being handled appropriately,
the clients are being handledappropriately, you know, you're
you're crossing your T's,dotting your I's and um yeah,
that was as frustrating as itwas fun.
SPEAKER_01 (13:33):
There is a lot to it that people don't understand
when they're just reading thearticle.
SPEAKER_03 (13:37):
Yeah, yeah, and and you realize too, like how
fragile and how valuable thatobjective data is when you start
to realize all the things youcould do to screw it up.
SPEAKER_01 (13:48):
But you didn't.
SPEAKER_03 (13:49):
No, no, I worked very hard not to.
SPEAKER_01 (13:52):
So did all of this background give you a unique
lens or a bias and that shapedhow you interpreted the data?
Or even acquired it or designedthe study?
SPEAKER_03 (14:01):
Honestly, I I did come in with a huge bias in
terms of my preference forneedle, at least in TPLs,
because I uh I felt anecdotallyI thought I saw a lot more
immediate post-ile bruising fromthe cutting needle.
Um, so I had to really work hardto make sure that all the
throughout the whole process, Iwas as blinded as possible to
the uh I was blinded to theneedle type when I was gathering
(14:23):
my data.
Um and it was surprising findingthat, you know, oh I that
anecdotal feeling.
I was like, oh yeah, we'redefinitely gonna have more
bruising from the the cuttingneedles.
Watch this.
And then it was like, oh, therewas 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 (14:44):
It's always cool to see what the evidence shows us.
SPEAKER_03 (14:47):
Yeah.
SPEAKER_02 (14:48):
So, Josh, this next set of questions is gonna be
really important for ourlisteners.
These are our big take-homes.
The first one's gonna be aboutthe veterinarian's perspective.
So, what is one piece ofinformation the veterinarian
should know about using reversecutting or taper point needles
for intradermal closure duringTPLOs?
SPEAKER_03 (15:05):
They both work.
Um, you know, our our ouroutcomes um for the patients
were good either way.
We didn't have any significantdifferences in the complication
rates.
Um, you know, the nice thingabout TPLOs, especially in this
population where we really triedto eliminate any confounding
factors from like comorbidities,is TPLO patients are usually
healthy, happy, young tomiddle-aged, you know, dogs that
(15:27):
want to go back to ripping andtearing on the ground.
So um, if there's a particularneedle that a primary care
veterinarian or surgeon feelsthat they have a better outcome
with on their TPLO introdumclosures, go for it.
SPEAKER_02 (15:40):
Um said.
And for the clients, what's onething you wish more people
understood about this topic?
SPEAKER_03 (15:48):
It's not black or white.
Um, you know, there's a lot ofthings in science and medicine
where they're it's easy to forman opinion because of Dr.
Google.
But um, understanding there's alot of clinical discretion and
getting objective data is ishard.
SPEAKER_01 (16:02):
Thank you, Josh, for being with us.
As we wrap up, we like to have alittle bit of fun with a few
questions.
Uh so what is your favoriteanimal fact?
You know, that fact that you digout when conversation's a little
bit at a lull and people arelike, no, I didn't know that.
SPEAKER_03 (16:16):
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-seaanglerfish are probably one of
the more extreme examples ofsexual dimorphism in animals and
have a very unique strategy tomating, which has been termed
(16:39):
sexual parasitism.
Um, so the male anglerfish issignificantly smaller than the
female.
They have uh there's certainspecies that are literally
unable to eat because they don'thave an appropriately um formed
digestive system.
Um it's completelyunderdeveloped, and basically uh
they're just swimming bags ofgametes whose only purpose in
(17:00):
life is to find a female, latchon, um, and at which point they
become embedded to the femalepermanently, um, where they'll
even start to share a bloodsystem, uh, blood supply uh and
are functionally just uh a setof gametes that they can use
when appropriate.
SPEAKER_01 (17:21):
A sweep meet set of gametes.
That's awesome.
All right, well, uh let's seewhat you have for this one then.
What do you think is the mostbeautiful animal?
SPEAKER_03 (17:30):
Look up the greater Po-2.
That one just makes me laugh.
SPEAKER_01 (17:34):
Tell us what I don't know what that is.
SPEAKER_03 (17:36):
Uh the Greater Potu is one of the more it's uh
common burden um South America.
Uh really interesting lookinganimal, but um, I think they're
gorgeous.
SPEAKER_01 (17:46):
So why?
Why do you think it's sobeautiful?
SPEAKER_03 (17:49):
Um makes me laugh.
SPEAKER_02 (17:53):
Okay, that's fair.
SPEAKER_03 (17:54):
Functional makes me laugh.
SPEAKER_02 (17:56):
Definitely gonna look that up after this.
Can you spell it?
I'm Richard, look it up.
SPEAKER_03 (17:59):
E-O-T-O-O.
SPEAKER_02 (18:00):
Okay, perfect.
Thank you.
Even the name is funny.
Awesome.
Well, thank you so much, Josh.
We appreciate you being herewith us today and also for
sharing your words too withJavma.
SPEAKER_03 (18:10):
Yeah, thank you so much for having me.
Um, and hopefully I can getanother paper or two through you
guys uh in the future.
SPEAKER_02 (18:16):
Awesome.
We'll be looking forward to itfor sure.
And for our listeners, you canread Josh's full article on
Javma.
I'm Sarah Wright here with LisaFortier.
Be sure to tune in next week foranother episode of Veterinary
Vertex.
And don't forget to leave us arating and review on Apple
Podcasts or wherever you listen.
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