Page 114 - Manual of Equine Field Surgery

110 LIMB SURGERIES

occurs. This may be related to performing surgery

too soon after diagnostic anesthesia, traumatic

surgical technique, excessive postoperative move-

ment, or incisional site problems. Ideally, surgery

should not be performed for a minimum of

2 weeks after diagnostic anesthesia of the palmar

digital nerve. Surgical technique and handling of

the nerve should be as atraumatic as possible,

and excessive dissection minimized. Adequate

postoperative rest and proper bandaging tech-

niques should be emphasized to the owner. Loss

of the hoof wall as a result of ischemia is a rare

but possible complication. Reasons for its occur-

Figure 18-5 Exposure of the palmar digital nerve in
rence are not well understood.4
the proximal and distal incisions t1sed in Black's

method of neurectomy.

ALTERNATIVE PROCEDURES

Black's Technique

This method of neurectomy allows for removal of

a longer section of nerve, decreasing the chances

of accessory nerve branch innervation to the

region. The proximal nerve ending may also lie

deeper ill the incision, potentially decreasing the

incidence of neuroma formation. 5

A 2-cm skin incision is made over the abaxial

border of the DDFT just above the medial or

lateral cartilage of the third phalanx in the distal

pastern region. The incision is extended carefully

through the subcutaneous tissue. Blunt dissection

is used to isolate the palmar digital nerve. Identi-

fication of the nerve is confirmed by crimping of Figure 18-6 The nerve has been transected proxi-

the nerve after it has been stretched and released mally and pulled through the distal incision in Black's

and palpating longitudinal fibers when the nerve method of neurectomy.

is stretched over the smooth portion of an instru-

ment. Closed Kelly forceps are placed below the

nerve, and traction is applied to identify the loca-

tion of the nerve in the proximal pastern region.

A 2-cm incision is made in the proximal pastern

region distal to the base of the proximal sesamoid

bone directly over the nerve being held ill trac-

tion. The nerve is isolated in this region, and trac-

tion is applied to the proximal and distal ends to

ensure the same nerve is exposed through both

incisions (Figure 18-5). A new scalpel blade is

then used to transect the nerve as proximal as pos-

sible through the upper incision. Traction is

applied to the distal end of the nerve in the distal

incision, and a 6- to 8-cm portion of nerve is

stripped through the incision (Figure 18-6). The

exposed nerve is then severed as distally as possi- Figure 18-7 Two-day postoperative view of the inci-

ble, and the skin is closed routinely (Figure 18-7). sions used in Black's method of neurectomy.