Page 72 - Manual of Equine Field Surgery

68 LIMB SURGERIES

by passing a groove director or forceps under

the annular ligament and palpating the distal end

of the ligament (Figure 10-4). Care should be

taken to exclude the proximal digital annular lig-

ament. The annular ligament is then transected by

passing a bistoury knife underneath the ligament

and transecting the ligament (Figure 10-5, A, B)

or by passing the groove director underneath the

ligament to guide a scalpel blade' (Figure 10-5, C).

Care must be taken to not incise the skin if the

bistoury knife is used. Alternatively, the annular

ligament can be transected with scissors. A small

subcutaneous plane is created for 1 blade of the

scissors, and the annular ligament is transected by

closing the blades of a scissors passed so that one

blade of the scissors is deep to the annular liga-

ment and the other blade superficial to the liga-

ment in the subcutaneous plane created2 (Figure

10-6). The tendon sheath can then be lavaged as

requited by the primary problem.

Figure 10-1 Appearance of a limb with constriction If the incision in the proximal tendon sheath is

of the palmar annular ligament.
large, it can be closed with No. 2-0 absorbable

suture. Subcutaneous tissues are closed with No.

2-0 absorbable suture. The skin is closed in an

interrupted pattern.

Digital neurovascular

bundle
. ·~
(the circle) ~ . - DDF tendon

Tendon

' . . sheath
. .. ---·

- SDF tendon

~t:;,,:f;~

B

A

Figure 10-2 The palmar-plantar annular ligament attaches on the abaxial surfaces of the proximal sesamoid bones

and partially surrounds the tendon sheath blending with its palmar-plantar wall and making up the palmar-plantar

wall of the fetlock canal. A, Lateral view. B, Cross section.