Page 68 - Manual of Equine Field Surgery
P. 68
l 64 LIMB SURGERIES
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Figure 9-11 Modified far-near-near-far pattern. ~~t:;;._J: U-,"' . ,..
Figure 9-13 Three-loop pulley.
angles. The initial loop is placed perpendicular to
the long axis of the tendon in a near-far pattern.
The second loop is placed in a plane 60 degrees
relative to the initial loop with bites taken similar
distances apart from each tendon end. The final
loop is placed in a far-near pattern 60 degrees
from the second loop (Figure 9-13).
'ffe-e.r>..t>t;;.-X~-~ - POSTOPERATIVE CARE
Figure 9-12 Modified compound locking loop.
Flexor Tendon Lacerations
No suture pattern or material provides the
Modified Compound Locking Loop strength required for flexor tendon function after
This pattern is strong and works best in flat repair.4'9'10 Therefore, during the early stages of
tendons or ligaments, but it can also be used in tendon healing, the repair must be protected from
round tendons. A superficial transverse bite locks weight-bearing forces with cast application or
around small groups of fibers to decrease pull- other external support. External support should
through of larger vertical bites approximately 2 be provided for a minimum of 6 to 8 weeks fol-
cm from the tendon end. The pattern starts with lowing repair. After this period, support should be
a superficial transverse bite about 1 cm wide. A gradually reduced. An elevated extended heel shoe
vertical bite is then placed through both tendon and/or splint should be provided for the follow-
ends, a11d a similar transverse bite is taken in the ing 4 to 6 weeks. The optimal extent of heel ele-
opposite tendon end. A vertical bite is then taken vation required has not been determined, but the
from the distal tendon end to the proximal tendon initial hoof angle achieved is typically between 65
end and tied to the start of the first transverse bite. and 75 degrees. Heel elevation and extension are
A similar but wider locking loop is next placed then gradually reduced over the next 12 weeks to
slightly closer to the tendon ends' (Figure 9-12). adapt the tendon to increasing tension. Some
Alternatively, both locking loops can be placed as horses require long-term heel extension after
a continuous pattern.4 flexor tendon transection.
Repair of superficial digital flexor tendons iI1
Three-Loop Pulley the hind limb may benefit from Kimzey splint
This pattern is strong and has less gap formation application rather than half limb cast application.
than other repair patterns. 8'9 It works best on Because hock flexion is normally accompanied by
round tendons such as the deep digital flexor fetlock flexion, tension in the superficial digital
tendon in the metacarpal region. The end result is flexor tendon is increased when a horse flexes its
three loops equally dividing the cross-sectional hock but is constrained from fetlock flexion by a
area of the tendon and intersecting at 60-degree half limb cast. The Kimzey splint supports the
