Page 84 - Manual of Equine Field Surgery
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CHAPTER 13
Distal Check Ligament Desmotomy
Joanne Kramer ·
INDICATIONS POSITIONING AND PREPARATION
The primary indication for distal check liga- The horse is positioned in lateral recumbency
ment desmotomy is deep digital flexor tendon with the affected limb tip. When both limbs are
(DDFT) contracture with coffin joint contrac- affected, the distal check ligament on the down
ture (Figure 13-1). It is also occasionally used in side can be approached medially. Alternatively, the
the treatment of metacarpophalangeal flexural horse may be positioned i11 dorsal recumbency
deformities and in the treatment of caudal foot when the condition is bilateral. The circumference
lameness with upright hoof wall or pastern con- of the limb should be clipped and prepared asep-
formation. tically from the fetlock to the mid carpal region.
EQUIPMENT PROCEDURE
Specialized instruments are not required for A 6-cm skin incision is made near the distal end
this surgery. The foot should be trimmed of the proximal third of the metacarpus over the
and examined for subsolar abscesses. Toe exten- DDFT (Figure 13-5). The approach can be per-
sions are applied in some cases to protect the formed on the lateral or medial aspect of the limb.
toe and to provide a lever arm during breakover The lateral approach is generally simpler and is
to gradually stretch the DDFT (Figures 13-2 and farther from the neurovascular bundle. The sub-
13-3). cutaneous tissues and palmar fascia are incised,
and the intersection between the distal check lig-
ament and DDFT is palpated or visualized (Figure
ANATOMY 13-6). The intersection between the DDFT and
distal check ligament is usually found best by pal-
The distal check ligament wraps around the pation with fingers or the tip of an instrument.
DDFT on the dorsal and lateral surface of the Occasionally, it can be visualized. Because of the
DDFT and often forms a slight C shape around C shape of the distal check ligament, it often
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the DDFT (Figure 13-4). The palmar vein, artery, wraps around the DDFT such that the DDFT is
and nerve lie close to the DDFT and distal check deep to the intersection of the superficial digital
ligament (see Figure 13-4). Care should be taken flexor tendon and distal check ligament.
to not exteriorize or transect these with the check Blunt dissection between the distal check liga-
ligament. ment and DDFT with a curved Kelly forceps or
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