Page 67 - Manual of Equine Field Surgery
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Mid Metacarpal-Metatarsal Tendon Laceration Repair 63
Figure 9-10 Extensive lavage during the initial stages
of laceration repair.
Figure 9-8 Kimzey splint support for a deep digital
flexor tendon laceration. An extended elevated heel
shoe has also been placed on the limb for support lization without tendon suturing. If the laceration
during bandage changes. involves greater than 750/o of the cross-sectional
area of the tendon, tendon suturing may offer
similar benefits to repair of complete transec-
tions."
Many extensor tendon lacerations have a sig-
nificant degloving component and extensive soft
tissue trauma, which precludes reconstruction.
With appropriate wound care, these lacerations
can heal by second intention and often have
minimal functional impairment. Fibrosis between
the tendon ends eventually results in a mechani-
cal link between. the tendon ends and, in marry
cases, return of extensor function of the digit. 6
However, if the wound is amenable to primary
closure and the tendon ends are transected
cleanly, primary tendon repair is preferable.
Suture Patterns for Tendon Laceration Repair
Modified Far-Near-Near-Far Pattern
Figure 9-9 PVC splint support for an extensor This pattern is the simplest pattern to perform,
tendon laceration.
and is best used in flat tendons, The needle is
placed perpendicular to and approximately 1.5 cm
from the proximal tendon end for the initial far
and early strength of the repair.t'" If the ends bite. The needle then enters the distal tendon end
of the flexor tendon are extensively retracted, 0.5 to 1 cm from the end for a near bite in a posi-
swollen, or discolored or the wound appears to be tion slightly axial to the far bite. It is then looped
significantly infected, the area should be debrided back to the proximal end of the tendon, and a near
and allowed to heal by second intention. In select bite is taken 0.5 to 1 cm from the end in the same
cases, delayed primary closure can be performed plane as the previous near bite. The suture is then
with or without tendon suturing. All situations brought to the distal end, and a far bite is taken in
require a minimum of 6 weeks of cast or splint the same plane as the initial far bite 1 to 1.5 cm
support. Partial flexor tendon lacerations can be from the end. The two far ends are then tied
managed with wound closure and limb immobi- (Figure 9-11).
