Page 74 - Manual of Equine Field Surgery

70 LilYIB SURGERIES
Figure 10-6 The annular ligament can also be
transected with scissors. A, A small subcutaneous
plane is created for one blade of the scissors, and
B, the annular ligament is transected by closing
the blades of a scissors passed so that one blade of
the scissors is deep to the annular ligament and
the other blade is superficial to the ligament i11 the
subcutaneous plane created.
POSTOPERATIVE CARE
; f d,1~.toperative (are
Bandaging: A sterile dressing is placed over the
incision and a half limb bandage is applied. The
initial bandage is changed 24 hours after surgery.
Subsequent bandage changes are performed at 4-
to 5-day intervals or more frequently if indicated.
Bandaging is applied for a minimum of 4 weeks
regardless of whether the open or closed technique
is performed.
Exercise Restridions: Stall rest is provided for 1 O
days, after which a gradual increase in daily hand-
walking is important to minimize adhesion forma-
tion. In cases without underlying tendon pathology,
light daily lunging at a trot or limited small paddock
turnout may be performed 3 weeks postoperatively.
Gradual return to work may begin in 6 weeks or as
indicated by the healing of any underlying tendon
. .
lOJUry.
Medications: Phenylbutazone is administered at
4.4 mg/kg BID for the initial 24 hours and at
2.2 mg/kg BID for an additional 5 days. Further
EXPECTED OUTCOME
After desmotomy, the lower limb profile has
mild to moderate symmetrical
resulting from release of the constricting liga-
ment. This decreases over time, but it is rare
for a completely normal cosmetic appearance to
return. The prognosis for soundness is good for
cases with primary constriction or thickening of
the annular ligament. Cases with minor tendon
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phenylbutazone therapy is. dictated by underlying
tendon damage and the level of lameness present.
Antibiotic therapy is continued in cases with preex-
isting infection and in select cases where delayed
incisional healing is anticipated.
Suture Removal: Skin sutures are removed
12 days postoperatively.
lntrasynovial Medications: lntrasynovial so-
dium hyaluronate is a useful adjunctive therapy
in cases where adhesions have b.een transected
or a high level of inflammation is present within
the sheath. Although sodium hyaluronate has
been shown in an experimental adhesion model
to decrease adhesion formation and increase
3
hyaluronic acid content within the digital sheath,
no products are specifically labeled for digital
sheath use. The author has used 20 to 40 mg
of sodium hyaluronate labeled for intraarticular
use at the time of surgery and 10 to 14 days
postoperatively.
lesions can also have a good prognosis, but exten-
sive tendon lesions or significant sheath adhesions
limit future soundness. The prognosis is guarded
enlargement for cases with septic tenosynovitis.
COMPLICATIONS
Complications include wound dehiscence, septic
tenosynovitis, synovial fistula formation, and
adhesions. Complications are rare following the