LIVER BIOPSY Biopsy of the hepatic margin by the "guillotine" method. Place a loop of suture around the protruding margin of a liver lobe. Pull the ligature tight and allow it to crush through the hepatic parenchyma before trying it. Using a sharp blade, cut the hepatic tissue approximately 5mm distal to the ligature. As an alternative, place several overlapping guillotine sutures around the margin of the lesion and excise it.

BIOPSIES

GENERAL INFORMATION

• Type and extent of treatment depends on tumor type, whether the mass is in a difficult location for reconstruction, and whether the diagnosis could change the treatment plan.
• Pretreatment biopsy is NOT indicated if knowledge of the type would not alter therapeutic regime or when the biopsy procedure is as dangerous as the treatment.

 

MOST COMMON COMPLICATIONS AND DIFFICULTY

• Failure to obtain a diagnostic sample.
• Not going deep enough into the tumor for a diagnostic biopsy. Many times the biopsy is only into the peritumor tissue or capsule/pseudocapsule tissue.
• Biopsy location poorly planned in regards to definitive surgery and closure.

"EXPERTS' ADVICE"

• It is often preferable to obtain a large biopsy sample from the center of the mass to secure the diagnosis.

 

A circular Baker punch is an easy way to obtain a skin biopsy and the wound can be closed with a simple interrupted or cruciate mattress suture pattern. The Baker punch can also be used to obtain intestinal or liver biopsies as well and similar closure patterns can be used. The liver can also be biopsied using a guillotine technique where the suture is used to slice through the organ and left behind as a ligature.

BIOPSIES:
SUTURE AND NEEDLE OPTIONS

	Brand		Needle Type	Needle Reference
	Main Choice	Also Possible		Main Choice	Also Possible
LIVER/INTESTINE	MONOCRYL*		Taper Point Reverse Cut	RB-1, SH	SH-1, CT-3 FS-2, FS-1
SKIN	ETHILON*	PROLENE*	Taper Point Reverse Cut	RB-1, SH	SH-1, CT-3 FS-2, FS-1
LINEA ALBA	MONOCRYL* (young) PDS* II (adult)	VICRYL* PLUS	Taper Point Reverse Cut	SH-1, SH, CT-2, CT-1	RB-1, CT-3 FS-2, FS-1, FS, FSL, X-1, CP-2, CP-1
SUBCUTANEOUS	MONOCRYL* VICRYL* PLUS	PDS* II VICRYL*	Taper Point	RB-1, SH, CT-2, CT-1
SKIN CLOSURE	ETHILON* PROLENE*	Silk	Reverse Cut	FS-2, FS-1, FS	FSL, CP-2, CP-1, KS

	Cat/Small Dog (20 lbs or less)	Medium Dog (20-45 lbs or less)	Large Dogs (50 to 75 lbs)	Giant Dog (75 lbs +)
LIVER/INTESTINE	4-0 or 3-0	4-0 or 3-0	3-0	3-0
SKIN	4-0 or 3-0	4-0 or 3-0	3-0	3-0
LINEA ALBA	3-0	3-0 or 2-0 or 0	2-0 or 0	0 or 1
SUBCUTANEOUS	4-0	4-0 or 3-0	3-0 or 2-0	2-0
SKIN CLOSURE	4-0	4-0 or 3-0 or 2-0	3-0 or 2-0	2-0

 

Use the suture selection tool for specific product code recommendations.