Page 99 - Zoo Animal Learning and Training

96 Section I: Diagnostics and Planning

biceps fascia is incised behind the stifle taking care to only incise
this fascia and no underlying tissue. Reflection of the fascia caudally
reveals the underlying common peroneal nerve (Figure 9.7). The
fascicular biopsy is performed as described above. The incision in
the biceps fascia is closed followed by biopsy of the lateral head of
the gastrocnemius muscle. The procedure concludes with subcuta-
neous tissue and skin closure.

Thoracic Limb
In the thoracic limb, the ulnar nerve and medial head of the tri-
ceps brachii and superficial digital flexor muscles are biopsied
through a single incision (Figures 9.8 and 9.9). The ulnar nerve is
also contained in a neurovascular bundle, so care is taken as with
the tibial nerve. The medial aspect of the thoracic limb is clipped
and prepared. An assistant may be needed to hold the upper tho-
racic limb out of the field. A linear proximal to distal incision
centered over the medial aspect of the elbow is made. After dis-
section through the subcutaneous tissue, the ulnar nerve is seen
coursing in a cranial to caudal direction just distal to the medial
condyle of the humerus and olecranon. The medial head of the
triceps is biopsied proximal to the ulnar nerve and the superficial
digital flexor muscle biopsied distal to the nerve. These samples
are prepared as above and the fascia, subcutaneous tissue, and
skin closed.

Video clips to accompany this book can be found on
the companion website at:
www.wiley.com/go/shores/neurosurgery

Figure 9.9 Fascia cleared for biopsy of the biceps muscle (single arrow) and References
superficial digital flexor muscle (double arrow) as well as ulnar nerve (dou- 1 Braund KG. Nerve and muscle biopsy techniques. Prog Vet Neurol 1991;2:35–56.
ble arrowhead). 2 Dickinson PJ, LeCouteur RA. Muscle and nerve biopsy. Vet Clin North Am Small
Animal Pract 2002;32:63–102.
3 Lecouteur RA, Williams DC. Neurodiagnostics. In: Tobias KM, Johnston SA (eds)
incision to be made centered caudal to the stifle. After incising Veterinary Surgery: Small Animal. St Louis, MO: Elsevier Saunders, 2012: 351–356.
through the skin and subcutaneous tissues, the biceps femoris mus- 4 Lorenz MD, Coates JR, Kent M. Confirming a diagnosis. In: Handbook of Veterinary
Neurology, 5th edn. St Louis, MO: Elsevier Saunders, 2011: 89.
cle is visualized and a 1 × 1 × 2 cm block of tissue is excised using a 5 Braund KG, Walker TL, Vandevelde M. Fascicular nerve biopsy in the dog. Am J Vet
#11 scalpel blade and processed as described earlier. Next, the Res 1979;40:1025–1030.