Page 105 - Manual of Equine Field Surgery

Deep Digital Flexor Tenotorny 101

ALTERNATIVE PROCEDURES

Tenotomy at the level of the mid pastern has been

described.9 The procedure is performed under

general anesthesia. A vertical 3-cm midline in-

cision is made on the palmar aspect of the mid

pastern. The incision is continued through the
,!)l_p&'«>t;;.;l,·o.,,,,._
subcutaneous tissue and digital flexor tendon
Figure 16- 7 Transection of the deep digital flexor

tendon. sheath. Curved forceps are placed- under the

tendon, and it is transected with a scalpel. The

incision in the tendon sheath is closed with No.

2-0 absorbable suture. The subcutaneous tissues
EXPECTED OUTCOME
are closed with 2-0 absorbable suture and the skin

is closed in an interrupted pattern.

Deep digital flexor tenotomy is a salvage proce-

dure, although some horses may become sound

for athletic activity. The intended goal should be

limited to an improvement in comfort level and COMMENTS

pasture soundness. Severe chronic cases of coffin

joint contracture may have such severe joint The DDFT can be isolated and elevated outside

capsule and surrounding tissue contracture that the incision with curved forceps as has been tra-

limb position may not improve significantly after ditionally described." During standing surgery,

tenotomy.v" we prefer to use the modified table knives

The prognosis for horses with laminitis likely described by Redden because the neurovascular

depends on tl1e condition of P3 and blood supply. structures are easily protected from transection

An improvement in pain, but not survival rate, without having to exteriorize the tendon. Because

has been reported in horses with acute refractory of the anatomic location and peritendinous

laminitis.7 In selected cases of chronic laminitis, attachments, tenotomy at the level of the pastern

an improved prognosis for survival has been may provide greater release than tenotomy at the

reported.8 mid metacarpal level.11 No difference in outcome

has been demonstrated between the two tech-

niques, and we prefer mid metacarpal tenotomy
COMPLICATIONS because of the lack of tendon sheath in the mid

metacarpal region and the more proximal loca-

Incisional dehiscence or drainage is rare. Sever- tion for standing surgery.

ance of the palmar artery, vein, or nerve is possi-

ble and care must be taken that these structures

are not isolated with the DDFT. Pain following

tenotomy in foals with contracture may be signif- REFERENCES

icant because of stretching of the joint capsule and

soft tissue and can be managed with nonsteroidal l. Redden RF: Shoeing the laminitic horse. In Redden

antiinflammatory medication. Occasionally, tem- RF, editor: Understanding laminitis, Lexington,

porary heel elevation is used to allow for a more 1998, The Blood Horse Inc.

gradual change in foot conformation. Hyper- 2. Sullins KE: Standing musculoskeletal surgery. In

extension of the coffin joint may occur and is Bertone A, editor: Standing surgery in the horse,

managed with heel extension and elevation. Vet Clin N Am Equine Pract 7:687, 1991.

Superficial digital flexor tendonitis may result 3. Nickels FA: Laminitis. In Ross MW, Dyson SJ,
editors: Diagnosis and management of lameness in
from the increased strain on the superficial digital the horse, Philadelphia, 2003, WB Saunders.

flexor tendon. Recurrent infection, abscessation, 4. Redden RF: Shoeing the laminitic horse, Proc Am

and sequestration of P3 are associated with Assoc Equine Pract 43:356, 1997.

chronic pain. If chronic pain persists, flexural 5. Adams SB, Santschi EM: Management of congeni-

deformity of the metacarpophalangeal joint may tal and acquired flexural deformities, Pro.~sSOf

occur. Equine Pract 46:117, 2000. \

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