Page 111 - Manual of Equine Field Surgery

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CHAPTER 18

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Palmar-Plantar Digital Neurectomy

Joanne Kramer

surgery is performed> the lateral side of the upper
INDICATIONS

forelimb and the medial side of the lower forelirnb

are operated on initially. The horse is then rolled
Chronic lameness that improves significantly after onto the opposite side and the procedures are.

palmar/plantar digital anesthesia and has not repeated. Alternatively> the horse can be placed in

improved with alternative treatment options. dorsal recumbency with the limbs extended or

Typical indications include selected cases of nav- flexed on the sternum.

icular disease, navicular bone fractures> wing frac- When possible, surgery time is decreased by

tures of the third phalanx> idiopathic heel pain, having two surgeons operate simultaneously. The

and palmar-plantar foot injuries (Figure 18-1).
circumference of the limb should be clipped and

prepared aseptically from the fetlock distally.

EQUIPMENT

ANATOMY
Specialized instruments are not required for the

guillotine or Black's method of neurectomy.

Perineural capping requires Gerald or similar The palmar-plantar branch of the palmar-plantar

smooth-tipped forceps (Figure 18-2). digital neurovascular bundle lies in the space

between the palmar/plantar border of the pastern

and the abaxial border of the deep digital flexor

POSITIONING AND PREPARATION tendon (DDFT). The nerve is just palmar/plantar

to the artery and is found just deep to the liga-

This surgery can be performed with the horse ment of the ergot. The presence of small accessory

standing or under general anesthesia. Maintaining nerve branches varies; when present, they often lie

sterile and atraumatic technique is more difficult palmar/plantar and deep to the ligament of the

during standing surgery because of the proximity ergot.

of the ground and inadvertent limb movement.

Standing surgery is performed with the horse

under sedation with local anesthetic over the PROCEDURE

palmar digital nerves at the level of the sesamoid

bones. Peripheral anesthesia is also beneficial A 3-cm skin incision is made over the abaxial

when the surgery is performed under general border of the DDFT in the mid to distal pastern

anesthesia. region (Figure 18-3, A). The incision is extended

Horses under general anesthesia are placed in carefully through the subcutaneous tissue. Blunt

lateral or dorsal recumbency. 'When bilateral dissection is used to isolate the palmar digital

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