Page 64 - Manual of Equine Field Surgery

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CHAPTER 9

Mid Metacarpal-Metatarsal Tendon Laceration Repair

Joanne Kramer

INDICATIONS • imal to the navicular bursa within the hoof

capsule. The distal end of the sheath and navicu-

lar bursa are separated by the transverse lamina.
Treatment of flexor and extensor tendon lacera-

tions iI1 the metacarpal or metatarsal region that In the mid metacarpal-metatarsal region, the

do not involve the digital sheath (Figure 9-1). Care cross section of the flexor and extensor tendons

of lacerations involving the digital sheath requires varies from flat to circular (Figure 9-3).

intensive management to treat synovial structure

sepsis and is discussed elsewhere!" (Figure 9-2).

ASSESSMENT AND SURGICAL PROCEDURES

EQUIPMENT Stabilization

A brief observation of the laceration and limb
Cast material and associated supplies are essential. position is made and the need for immediate

Recommended suture materials for tendon repair stabilization is determined. Elevation of the toe

include nylon, polydiaxone, and coated Kevlar indicates complete deep digital :flexor tendon

(FiberWire, Arthex, Naples, Fla.). Size No. 2 or laceration (Figure 9-4), and mild to moderate

larger suture material is used.
dropping (hyperextension) of the fetlock suggests

superficial digital flexor tendon laceration or

partial disruption of the s11spensory apparatus

POSITIONING AND PREPARATON (Figure 9-5). Severe hyperextension of the fetlock
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suggests transection or complete disruption of

The horse is positioned in lateral recumbency the suspensory apparatus (Figure 9-6). Buckling

with the affected limb positioned for access to the forward at the fetlock or difficulty extending

laceration. The circumference of the limb should the distal limb suggests common or long digital

be clipped and prepared aseptically from at least extensor tendon rupture (Figure 9- 7).

the fetlock to the mid carpal/tarsal region. The need for stabilization must be balanced

against the need to determine the extent of the

wound and to offer owners who have economic

ANATOMY concerns a general prognosis before proceeding

with potentially costly procedures. Examination

The proximal extent of the digital tendon sheath of the injury can be performed with the limb

is in the distal third of the metacarpal-metatarsal held up before stabilization is applied, but often

region. The distal end of the sheath lies just prox- a detailed examination is not possible until the

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