Page 90 - Manual of Equine Field Surgery

CHAPTER 14

Proximal Check Ligament Desmotomy

Joanne Kramer

INDICATIONS and cranial aspect of the superficial digital

flexor tendon at the musculotendinous junction

(Figures 14-4 and 14-5). From the lateral aspect,
Proximal check ligament desmotomy is used in

the management of metacarpophalangeal flexural the ligament lies adjacent to the proximal and

deformities (Figures 14-1 and 14-2) and in the medial aspects of the carpal tendon sheath. From

management of superficial digital flexor ten- the medial aspect, the ligament lies adjacent to,

donitis (Figure 14-3). and is fused with, the deep sheet of the flexor reti-
naculum. To gain access to the proximal check Iig-

ament from the medial aspect, the antebrachial

fascia must be incised where it is extended as the
EQUIPMENT

superficial sheet of the flexor retinaculum. This

exposes the tendon of the flexor carpi radialis
Gelpi or Weitlaner retractors, electrocautery, and muscle, which is retracted caudally to expose the

suction should be available for this procedure.
ligament.

The fibers of the proximal check ligament are

in two layers-superficial and deep.

POSITIONING AND PREPARATION The palmar carpal branch of the proximal

radial artery is the nutrient artery for the superfi-

The horse is positioned in lateral recumbency cial digital flexor tendon (SDFT). It is exposed at

with the affected side down. Bilateral cases are the proximal aspect of the ligament and runs in a

repositioned after 011e limb is complete. Alterna- distolateral direction between the superficial and

tively, dorsal recumbency can be used when the deep layers of the proximal check ligament.

condition is bilateral. Dorsal recumbency has the

advantage of natural hemostasis, but access to

the surgical site is awkward. The circumference of PROCEDURE

the limb should be clipped and prepared asepti-

cally from the carpus to the mid radial region. An 8- to 10-cm incision is made on the medial

aspect of the limb 1 cm caudal to the radius and

cranial to the cephalic vein. The incision starts 1

ANATOMY cm proximal to the level of the distal physis and

extends proximally (see Figure 14-4). The subcu-

The proximal check ligament originates on taneous tissues are incised and electrocautery is

the caudomedial aspect of the radius, courses used as needed to achieve hemostasis. The com-

obliquely, and inserts broadly on the medial municating bra11ch of the proximal radial vein

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