Page 50 - Manual of Equine Field Surgery

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Chapter 6

Periosteal Transection and Elevation

Rick D. Howard

INDICATIONS between the common and lateral digital extensor

tendons, a site with minimal soft tissue overlying

the radius. The surgical approach for treatment of
Performed alone for the treatment of angular

limb deformities iI1 foals with mild to moderate tarsal valgus is over the lateral malleolus of the

deformity or in combination with transphyseal tibia just proximal to the distal tibial physis

bridging for foals with more severe deformities. (Figure 6-2). The vertical skin incision is posi-

Most commonly used for treatment of carpal tioned either just cranial or caudal to the lateral

valgus and tarsal valgus but also for varus or digital extensor tendon. The surgical approach for

valgus deformities of the metacarpophalangeal or treatment of metatarsophalangeal or metacar-

metatarsophalangeal joints. pophalangeal angular limb deformities is on. the

concave side of the limb using an approach just

proximal to the distal physis of the 3rd metacar-

EQUIPMENT pal bone or the 3rd metatarsal bone. Periosteal

transection and elevation to augment growth at

the proximal physis of the first phalanx through
A hooked surgical blade and periosteal elevator.
a11 approach just distal to the proximal physis of

tl1e 1st phalanx may be indicated in certain

cases.
POSITIONING

Dorsal recumbency is preferred for bilateral PROCEDURE

procedures or when performed concurrent with

transphyseal bridging. Lateral recumbency is pre- Periosteal transection and elevation is performed

ferred for unilateral cases or for bilateral cases on the lateral aspect of the limb for treatment of

( with rolling) not requiring concurrent transphy- valgus deformities and on the medial aspect of the

seal bridging. limb for the treatment of varus deformities. A 3-

to 4-cm vertical incision is made in the skin and

subcutaneous tissues parallel to the long axis
ANATOMY of the bone beginning 1 to 2 cm proximal to the

physis and extending proximally. The incision is

The surgical approach for treatment of carpal carried to the level of the periosteum. Curved

valgus is over the distolateral aspect of the radius hemostatic forceps are used to bluntly dissect

just proximal to the distal radial physis (Figure between the periosteum and overlying soft tissues

6-1). The vertical skin incision is positioned extending from the distal aspect of the incision in

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