Page 52 - Manual of Equine Field Surgery

48 LIMB SURGERIES

POSTOPERATIVE CARE tion and elevation using a blind approach through

a I-cm-length skin incision. Using the blind tech-

nique, the surgical wounds are allowed to heal by
..
Postoperative Care second intention under a bandage. The primary

• advantages of the technique are the decreased sur-

Bandaging: Postoperatively, the surgical site is gical time and decreased incisional complications.

maintained under a bandage for 1 O to 14 days.

Suture Removal: If skin sutures are placed, they Postoperative care is essentially as described for

should be removed after 1 O to 14 days. the open technique for periosteal transection and

Exercise: The foal is strictly confined to a stall for elevation.

10 to 14 days. Exercise restrictio.n is instituted

postoperatively to reduce trauma to the asym-

metrically loaded physis and cuboidal bones and COMMENTS

is considered an essential component of the ther-

apeutic plan during postoperative convalescence. The differential diagnoses for angular limb defor-

The duration and degree of exercise restriction mities in foals include intercarpal or intertarsal

are dependent on the age of the foal and the ligament laxity, crushed carpal or tarsal bones,

severity of the angular limb deformity; however, distal radial or tibial physeal dysplasia, and physeal

strenuous exercise should not be allowed until the

angular limb deformity has been corrected. trauma resulting in premature closure of the

Other: The hooves should be-trirnrned to achieve physis. Preoperative radiographs are important to

balance and the foal maintained on a nutritionally confirm the source of the angular limb deformity

balanced diet. and to determine if surgical manipulation of the

growth plate is indicated for treatment of the defor-

rnity, Dorsopalmar (plantar) and lateral medial

radiographic views of the affected area will gener-

EXPECTED OUTCOME ally confirm the source of the angular deformity.

Periosteal transection and elevation is best

The expected degree of correction is proportional indicated for deformities associated with physeal

to the amount of growth expected to occur at the dysplasia. Periosteal transection and elevation

affected physis during the 6 to 8 weeks following requires a functioning physis to be effective. If the

surgery. It is considered that after this amount of physis is crushed, as occurs with Salter-Harris

time no further benefit is derived from periosteal type V or VI fractures, the procedure will not be

transection and elevation. In cases where partial effective because the physis is unable to respond.

but inadequate correction is achieved, repeated Angular limb deformities may also be associ-

surgery may be warranted provided adequate ated with the metaphysis or diaphysis of long

growth potential remains. In contrast to the bones; typically the third metacarpal or metatarsal

transphyseal bridge procedure, overcorrection of bones. These deformities are usually congenital

the angular limb deformity is not a complication and their repair is beyond the scope of this book.

of periosteal transection and elevation. Since its introduction into equine surgery in

1980, periosteal transection and elevation has

been widely accepted as an effective method for

COMPLICATIONS augmentation of axial limb growth in the treat-

ment of angular limb deformities.1•2 The effec-

Complications include incomplete correctio.n of tiveness of the procedure has been questioned.

the angular limb deformity, incisional dehiscence, The results of a study on the efficacy of periosteal

and development of arthropathy as sequelae to transection and elevation for the treatment of

the damage induced by asymmetric loading of the experimentally induced carpal valgus indicated

cuboidal bones during weight bearing. foals treated with stall confinement and hoof

trimming alone or with the addition of periosteal

transection and elevation demonstrated a similar

ALTERNATIVE PROCEDURES correction in angular limb deformity.3 Although

the results were significant, it is important to note

An alternative technique to the open technique as that the transphyseal bridge model for carpal

described involves performing periosteal transec- valgus used in that study may be an inadequate

•