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Clinical decision making
Comparing wound complications associated with midline and flank approaches for spaying cats
  1. Jenny Stavisky and
  2. Marnie Brennan
  1. Centre for Evidence-based Veterinary Medicine, University of Nottingham, Sutton Bonington, UK

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Bottom line

  • There is no evidence that either a flank or midline approach for spaying cats is consistently associated with more wound complications, and, overall, complication rates appear to be low.

Clinical scenario

Miss Tabby brings you a colony of feral cats she has trapped in her garden to be neutered. The cats cannot be handled and will be monitored postoperatively by visual inspection from at least 10 feet away. She asks you if they can be spayed via a flank approach so that she will be able to see the incision site more easily.

However, as the cats can only be monitored from a distance, and re-trapping after surgery would be difficult, any postoperative complications would be very difficult to address and could potentially pose a serious welfare concern. You wonder if using a flank approach would lead to more postoperative wound complications than a midline approach.

The question

In [female cats that are being neutered] does a [midline surgical approach as compared with flank] [decrease wound complications following surgery]?

Search parameters

The search strategy can be viewed at, and it is also available as a supplement to this article on Vet Record’s website at

Supplementary Material


Search outcome

  • One hundred and thirty-two papers were found in the Medline search.

  • One hundred and twenty-nine were excluded because they did not answer the question.

  • In total, three relevant papers were obtained.

  • Two hundred and twenty-one papers were found in the CAB search.

  • Two hundred and fifteen were excluded because they did not answer the question.

  • Four papers were excluded because they were review articles, in vitro research or conference proceedings.

  • In total, two relevant papers were …

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