Page 115 - Manual of Equine Field Surgery

Palmar-Plantar Digital Neurectomy 111

Perineural Capping

Perineural capping of the proximal nerve end may

be performed in an attempt to decrease painful

neuroma formation.' Controlled studies with

high case numbers are lacking, but if the tech-

nique can be performed atraumatically it is likely

beneficial. The palmar digital nerve is isolated and

exposed as for the guillotine technique. The distal

end of the nerve is severed. The end of the prox-

imal nerve is grasped with hemostats, and Gerald

or similar dressing forceps are used to free the

combined epineurium and perineurium (per-

ineural sleeve) from the nerve (Figure 18-8, A A

and B). After freeing of the perineural sleeve, the

proximal end of the nerve is sharply transected. If

sufficient nerve length is available, two partial

incisions in the nerve can be made before tran-

secting the nerve, The purpose of these incisions

is to slow axon regeneration and allow increased

time for the perineural capping seal.' After nerve

transection, the edge of the perineural sleeve is

grasped and pulled over the nerve (Figure 18-8,

C). The perineural sleeve is closed with one or two

interrupted sutures using 4-0 absorbable suture.

Subcutaneous and skin closures are routine.

Other techniques for neurectomy have been

described, including a method of tunneling the B

proximal nerve end into bone and the use of a

carbon dioxide laser to perform neurectomy, and

they appear to have good success rates.6•7

COMMENTS

Careful selection of cases should be performed.

Significant improvement in lameness after palmar

digital anesthesia is important, as well as an owner

who understands potential complications and will

provide excellent short- and long-term postoper-

ative management. A variety of techniques for

neurectomy are available, but no single technique c

has proven to be superior. Atraumatic technique Figure 18-8 Perineural capping on a cadaver limb.

and adequate postoperative rest are the essential A, The nerve ending is grasped with hemostats, and

components of all techniques. Although potential smooth-tipped forceps are used to strip the perineural

complications of neurectomy dictate limited use sleeve proximally. B, The perineural sleeve has been

of the procedure, palmar digital neurectomy can stripped proximally, and the nerve is exposed. C, After
severing the exposed nerve, the nerve ending retracts
offer significant pain relief and return to athletic proximally within the perineural sleeve. The perineural

function in horses that have not responded to sleeve is then closed with No. 4-0 suture material,

other treatment options.