Surgery for horses encompasses a range of procedures performed to diagnose, treat, or manage various medical conditions. These procedures may involve soft tissue or orthopedic interventions and require specialized techniques to accommodate the unique anatomical and physiological characteristics of equines. Common surgical procedures in horses include colic surgery, fracture repair, and arthroscopy. The success of equine surgery depends on numerous factors, including the type of procedure, the horse's overall health, and post-operative care. This page compiles peer-reviewed research studies and scholarly articles that explore surgical techniques, outcomes, and advancements in equine surgical practices.
Tulleners EP, Richardson DW, Reid BV.Three mares were treated for vaginal evisceration of a portion of the small intestine. Evisceration occurred in 2 mares shortly after breeding accidents in which the stallion's penis penetrated the vaginal fornix dorsal to the cervix. The affected bowel was replaced through the laceration, and the vaginal defects were sutured with the mares standing, utilizing epidural anesthesia. One mare recovered without complications, was subsequently bred, and delivered a foal with no difficulty. The other mare developed signs of a strangulating small intestinal obstruction 24 hours after the injury, nece...
Scott EA, Todhunter R.In 2 cases of chronic intestinal intussusception in horses, one involved jejunum and the other, ileum. The only clinical signs observed were intermittent colic. Surgery was performed on both horses, with successful outcomes.
Hinrichs K, Gentile DG, Hurtgen JP, Richardson DW.A testicular prosthesis was removed from the scrotum of a 3-year-old Quarter Horse stallion. The prosthesis had been placed in the left side of the scrotum 10 months earlier, after an unsuccessful attempt to reposition the retained left testis. Because of a persistent draining fistula on the scrotum, first noted 5 months after placement of the prosthesis, surgery was performed to remove the prosthesis. At surgery, the left testis was found in a fibrous mass surrounding the prosthesis. The left testis had descended after placement of the prosthesis, and its involvement in the fibrous tissue sur...
Rigg DL, Ramey DW, Reinertson EL.Respiratory distress and laryngeal paralysis were found to be caused by a Streptococcus equi abscess of cranial mediastinal lymph nodes, putting pressure on the trachea at the thoracic inlet. Surgical drainage was required to relieve the compression, and long-term antibiotic therapy was used to treat the bacterial infection. The trachea returned to normal diameter but left laryngeal hemiplegia persisted. Peritracheal abscesses should be considered in the differential diagnosis of inspiratory dyspnea of the horse.
Line SW, Hart BL, Sanders L.Males horses castrated prepubertally occasionally display stallion-like sexual and aggressive behavior as adults. A retrospective survey of 140 horse owners was undertaken to compare the effectiveness of prepubertal versus postpubertal castration on objectionable sexual and aggressive behavior. Of 94 geldings that had been castrated prepubertally (before 2 years of age), 20% to 30% displayed stallion-like sexual behavior and aggression toward horses, and 5% were aggressive toward people in a stallion-like manner. This occurrence of problem behavior was not significantly different from the occu...
Colbern GT, Aanes WA, Stashak TS.The case records of 47 mares with third-degree perineal lacerations or rectovestibular fistulae were examined to evaluate their fertility following surgical repair. Of 32 mares bred, 24 became pregnant, suggesting that surgical repair is indicated in any mare with sufficient genetic potential. Perineal trauma after surgical repair was recorded in 3 of 20 mares at subsequent parturition.
Sullins KE, Stashak TS, Mero KN.In 6 horses, 2 types of ischemic lesions were created in small intestinal segments by selective ligation of vessels and intestinal wall for 1, 2, or 3 hours. After confirming the ischemia by IV injection of sodium fluorescein, the ligatures were released. Five minutes later, the fluorescent patterns were documented photographically. Observed patterns ranged from normal (identical to that observed in unaffected bowel) to a patchy distribution of non-fluorescence (indicating incomplete perfusion). None of the experimental segments was normal when reevaluated 1 month later. The typical appearance...
Vaughan LC, Edwards GB, Gerring EL.Implants of carbon fibre, made by plaiting a tow of 10,000 filaments of Grafil type HT-S, were used to treat strains and ruptures of digital flexor tendons in 46 horses. The relevant clinical data, the techniques employed and an analysis of the results are described. Apart from two horses in which the implant was extruded and had to be removed, there were minimal untoward consequences of the surgery. Of the 34 horses with acute or chronic tendinitis, 14 returned to racing, seven were used as hunters and seven as hacks. Among the former group, seven suffered a further strain while racing but th...
Draeger J, Köhler L, Winter R.The larger the corneal graft, the more difficult is the excision of the button and especially suturing of the graft. The instruments and microsurgical unit are adapted to size and dimensions of animal surgery. The mathematical correlation between the diameter of the graft, the thickness of the cornea, and the length of the wound edges and suturing material can be calculated.
Knezevic PF, Fessl L.Thrombosis of the aorta as the cause of intermittent claudication in the horse appears to be rare. Two cases out of about 10 000 horses 1973-1984 are discussed. There are various views on its aetiology, whereby haemodynamic factors and disturbances of coagulation have been mentioned as well as parasites. For treatment surgical methods should be explored in addition to medical procedures. History, diagnosis and the attempt of an aortic thrombectomy in a 12 year old thoroughbred mare are described in this paper. A standardbred stallion was left untreated on owners wish.
Diehl M, Gerber H, Schifferli D, Nicolet J.A systemic investigation of wound infection in the horse after operative treatment of large wounds reveals that the age of the wound is of critical importance. The limit for an uncomplicated healing process lies around four hours. The duration of the operation itself is of little significance, the location of the lesion on the body of the horse, however, plays a major role. The pattern of isolated bacterial organisms is discussed in relation to the duration of hospital treatment. It is concluded that a systemic antibiotic therapy is of no value and that a local antibiotic therapy is only indic...
Becker M, Breuer D.The results of the ileus surgery in horses by a consistent performing of a known and standardised clinical and operative procedure are very good, provided that there are surgeons who have experience in abdominal surgery and that there is a co-operating team for the pre- and post-operative care.
Montgomery TC, McNaughton SD.A histological study of plantar digital nerve sections cut with a carbon dioxide laser in horses was conducted. A series of nerve cuts were made with variable power densities to determine the appropriate theoretical level which would yield the most desired tissue effects. Power densities in the lower ranges used appeared to provide tissue effects judged most likely to prevent neuroma formation through increased thermal sealing of the proximal stump at the axon level. Clinical observation and follow-up of horses subjected to laser neurectomy tend to support the reported concept that the laser i...
Collier MA, Lowe JE, Rendano VT.Materials fatigue and gross biocompatability of an implantable bone growth stimulator (BGS) were assessed in a 6-month trial using 6 ponies. The forelegs of each pony were implanted with a BGS; the right leg implant had the cathode and cathode lead preconnected by the manufacturer, and the left leg implant was connected at surgery. Evaluation was by radiographic and clinical examination at the beginning and end of the experimental period. Six of the 12 cathode leads (50%) and 7 of the 12 cathodes (58%) were broken at 6 months. All of the implanted preconnected cathode and insulated cathode lea...
Wolfers H, Böhm D.Etiology and therapy of equine esophageal obstipation are described in 79 cases seen at the Veterinary Surgery Clinic of the University of Munich.
Taylor PM, Hall LW.Anaesthesia was induced in 24 horses with xylazine and ketamine and maintained with halothane (12 cases) or enflurane (12 cases) in oxygen. Pulse rate, arterial blood pressure, arterial blood gas values, respiratory rate and tidal volume were measured at regular intervals during anaesthesia. Serial venous blood samples were taken for assay of glucose, urea, haemoglobin, packed cell volume, gamma glutamyl transpeptidase, aspartate aminotransferase, alanine aminotransferase and creatine kinase. Operating conditions and the horses' behaviour in the recovery period were also recorded. In the case ...
Becker M.During the last 10 years 268 laparotomies by a midline incision were performed. A high incidence of seromas, fistulas caused by suturing material and wound ruptures were observed. After finding only a small number of publications in the veterinary medicine about wound healing disturbances an analysis of the human medical literature was done. This induced the change of our surgical procedure and suturing technique: The midline incision and surgical management during the laparotomies in 14 horses suffering from colic were performed by a minimized trauma. The abdominal wall was closed layer by la...
Steenhaut M, Verschooten F, De Moor A.Arthrodesis of the pastern joint was performed in six horses with a history of acute trauma and in 10 horses with a history of chronic lameness of one to six months duration. Five surgical techniques were employed: curettage of the joint, lag screw compression and immobilisation in a plaster cast; curettage, compression using a T plate and immobilisation; drilling, lag screw compression and immobilisation; lag screw compression and immobilisation; and curettage and immobilisation. Pre- and postoperative clinical course are described together with significant radiographical findings. The best r...
Schneider RK, Mayhew IG, Clarke GL.The duration of anesthetic effect and the histopathologic changes resulting from a controlled freeze of the palmar and plantar digital nerves in the horse were evaluated. Two techniques were compared: (i) nerves were frozen by direct application of the cryoprobe after surgical exposure and (ii) nerves were frozen by percutaneous application of the cryoprobe to the overlying skin. Return of skin sensation and ability to detect a stimulus were used to determine return of nerve function. The duration of anesthetic effect was significantly (P less than 0.005) longer for nerves frozen after surgica...
Iuliano MF, Squires EL, Cook VM.A 2 X 2 cross-classified experiment was conducted to investigate the effect of age of equine embryo (7 vs 8 d postovulation) and method of transfer (surgical vs nonsurgical) on pregnancy rates at 50 d of gestation. Embryos were recovered 7 or 8 d postovulation using a Foley catheter and 3 liters of modified Dulbecco's phosphate-buffered saline (PBS). Upon identification, the embryos were placed in millipore-filtered PBS containing 20% heat-inactivated steer serum and maintained at room temperature until transferred. At the time of recovery, embryos were randomly assigned to be transferred eith...
Mackey VS, Pool RR.Fracture of the lateral wing of the third phalanx with secondary infection of the distal interphalangeal joint occurred in a neurectomized mare. Puncture of the sole may have been the inciting cause, emphasizing the need for careful daily foot care in neurectomized horses.
van der Velden MA, Verzijlenberg F.The surgical treatment of eighty-nine horses and ponies suffering from chronic empyema of the maxillary sinus is reported. Treatment consisted in trephination and drainage of the sinus involved in thirty-six animals; the affected teeth were removed at the same time in fifty-three animals in which sinusitis was caused by an alveolitis. The recovery rate was seventy-five per cent in group one and seventy per cent in group two. Postoperative treatment is also reported and attention is paid to complications which may occur during and after surgery.
Cox JE.A simple technique for castration of adult horses which results in first intention healing was devised. The technique involves a 'closed' castration with or without a transfixed ligature on the spermatic sac and suturing the scrotal skin with polyglycolic acid suture material. The postoperative course was characterised by mild oedema only and by rapid recovery. The results obtained during the course of removing 311 scrotal testes from horses and donkeys of all ages are described and discussed. The technique is readily applicable in the field.
Richardson DW.Fifteen longitudinal fractures involving the medial condyle of the third metatarsal bone were diagnosed in racing Thoroughbreds and Standardbreds. Twelve were repaired surgically with lag screws placed through stab incisions. Two of the horses suffered catastrophic fracture of the third metatarsal bone during recovery from anesthesia, and 3 more sustained complete fractures within 4 days of the repair. Of 3 horses with fractures treated without surgery, 2 healed without complication. Preoperative radiography did not demonstrate a nonlongitudinal fracture component in any of the horses that sus...
Stover SM, Steffey EP, Dybdal NO, Franti CE.Five horses were anesthetized similarly by use of xylazine, guaifenesin, thiamylal sodium, and halothane in oxygen on 3 consecutive days, and minor surgical procedures were performed. For 1 to 10 days after the last anesthetic exposure, clinical, hematologic, and serum biochemical features were monitored, and after necropsy, histologic examination of major organ tissues was performed. Predominant hematologic changes from base-line values included leukocytosis (maximal at 27 hours, 10,500 +/- 1,750 cells/microliter), neutrophilia (maximal at 51 hours, 7,485 +/- 1,719 cells/microliter), and lymp...
Diehl M, Gerber H, Schifferli D, Nicolet J.A systemic investigation of wound infection in the horse after operative treatment of large wounds reveals that the age of the wound is of critical importance. The limit for an uncomplicated healing process lies around four hours. The duration of the operation itself is of little significance, the location of the lesion on the body of the horse, however, plays a major role. The pattern of isolated bacterial organisms is discussed in relation to the duration of hospital treatment. It is concluded that a systemic antibiotic therapy is of no value and that a local antibiotic therapy is only indic...
Watt BC, Beck BE.Diagnosis and removal of a nasal polyp in a horse using standing chemical restraint and readily available equipment are described. Histopathology of the polyp and differential diagnoses are discussed.
Kalsbeek HC.Non-surgical correction of nephrosplenic entrapment of the left colon was attempted in 27 cases. In two cases the method failed and a laparotomy was necessary. Two other horses had a recurrence, one of which underwent laparotomy because of torsion of the caecal body.
Schaaf KL, Kannegieter NJ, Lovell DK.A Thoroughbred horse with bilateral laryngeal dysfunction was treated by placement of a long term tracheal cannula in order to restore full athletic function. The horse initially presented with right-sided arytenoid dysfunction that was considered to be due to a congenital malformation of the laryngeal cartilage. This was corrected by a right-sided laryngoplasty and ventriculectomy. The horse re-presented 1 year later with idiopathic left laryngeal hemiplegia. The decision was made to place a long-term tracheal cannula due to the low success rate and high complication rate associated with othe...
Andrews FM, Robertson JT.Functional obstruction of the right dorsal colon was found at surgery in a 6-year-old American Saddlebred gelding with a history of anorexia, depression, weight loss, and intermittent colic. Side-to-side anastomosis of the right dorsal colon to the small colon was done to bypass the obstruction. Histopathologic findings of the right dorsal colon and regional colonic lymph nodes were unremarkable. Surgical treatment was successful.
Jennings JE.A 21-year-old Appaloosa mare was presented with a pigmented cutaneous mass at the base of the right side of the neck. The diagnosis of phaeohyphomycosis due to pigmented fungi, known as Pyrenophora phaeocomes and Drechslera nobleae, was made based on a histopathology report followed by polymerase chain reaction (PCR) and 18S rRNA gene sequencing. The mass was surgically excised with clean margins, which is usually curative. Une jument Appaloosa âgée de 21 ans a été présentée avec une masse cutanée pigmentée à la base du côté droit du cou. Le diagnostic de phæohyphomycose causée p...
Stashak TS.The causes, clinical signs and various approaches to treatment of injuries involving the foot and pastern regions are reviewed, and the prognosis for each type of injury is discussed.
Bailey JV, Fretz PB.Two incidents of penetrating wounds into the abdominal cavity of horses are presented. In both events these had resulted in penetraton of the intestinal tract. Both animals had received only minimal veterinary attention in the acute stage and had survived with the formation of intestinal fistulae.Attempts at surgical repair resulted in failure in one animal and in closure of the fistula in the second with some subsequent cosmetic defect.
Sullins KE.Indications for performing orthopedic surgery on the standing horse include inability to tolerate general anesthesia, risk of worsening an injury during recovery from anesthesia, and cost. The surgeon should be aware that performing surgery in the standing horse can be more demanding and require more experience than the same procedures when the time and convenience of general anesthesia are available. Improved sedatives and analgesics have allowed more latitude because the horses now are more tolerant than when older agents were used. Common sense should be applied to each situation before the...
Cervantes C, Madison JB, Ackerman N, Reed WO.Between January 1985 and May 1989, 53 Thoroughbred horses (mean age 3.2 years) were surgically treated for dorsal cortical fractures of the third metacarpal bone (MC III). All horses were treated with cortical drilling through the fracture line (osteostixis). Diagnosis of the fractures was confirmed by xeroradiography. Lifetime racing records were obtained for all horses. Forty-seven horses returned to racing after surgery (89%). The mean time between surgery and the first race was 6.8 months. Horses had a mean of 10.9 starts before surgery and 16.1 starts after surgery. The mean earnings per ...
Brooks DE, McCoy DJ, Martin GS.Uterine rupture was diagnosed in 2 postpartum mares with hemorrhagic vaginal discharge. Both mares had abdominal pain, as evidenced by pawing, kicking at the abdomen, or attempting to roll. Peritoneal fluid analysis was useful in establishing a diagnosis. One mare had many RBC in the peritoneal fluid and was anemic; this mare was managed medically with oxytocin, antibiotics, and blood transfusion. The mare was able to raise her foal to weaning age. The second mare had many RBC, degenerate neutrophils, and intracellular and extracellular bacteria in peritoneal fluid. Surgical repair of the uter...
Hoskinson JJ, Wooten P, Evans R.Nonsurgical, percutaneous, transvenous removal of a catheter fragment embolus was performed in a 14-day-old Thoroughbred foal. A basket retrieval catheter was introduced into the jugular vein and manipulated under fluoroscopic guidance to remove the fragment from the right side of the heart. Percutaneous retrieval should be considered as an alternative to thoracotomy for retrieval of intracardiac or intravascular foreign bodies.
Fischer KD.A number of surgical interventions in ancient veterinary medicine were modelled on the same procedures in human medicine. This is discussed in some detail for the prolapse of the uterus and the couching of the cataract in horses. In the introductory section, the importance of Switzerland and neighbouring areas for the transmission of ancient veterinary medicine is highlighted.
Stolk PW, Lagerweij E.Using the semi-closed to-and-fro system, oxygen-halothane anaesthesia was produced in horses and ponies. It is concluded that the system described enables the equine veterinary practitioner to carry out moderately prolonged surgery (up to approximately 120 minutes) by a justifiable and relatively safe method.
Saroglu M, Aktas M, Olgun D, Arun SS.A tumor-like tissue mass of lateral-limbal site in the right eye of a 12-year-old Cob Pony mare was presented for surgical removal. The mass, covering the lateral limbus, bulbar conjunctiva and part of the cornea, was surgically removed, and the corneal defect repaired with a pedicle bulbar conjunctival graft. The mass was inflammatory in nature containing mononuclear cells. No recurrence or complication occurred at 6- and 12-month follow-up examination.
Becker M, Breuer D.The results of the ileus surgery in horses by a consistent performing of a known and standardised clinical and operative procedure are very good, provided that there are surgeons who have experience in abdominal surgery and that there is a co-operating team for the pre- and post-operative care.
Hanson RR, Nixon AJ, Gronwall R, Meyer D, Pendergast J.Postoperative abdominal fluid changes were compared in 2 groups of horses; those undergoing double small-colon resection and anastomosis (n = 10) and those undergoing exploratory celiotomy alone (n = 5). Peritoneal fluid was collected before surgery and on postoperative days 1, 3, 5, and 7. Total and differential nucleated cell counts, RBC numbers, and total protein and fibrinogen concentrations were evaluated. In both groups, all values were significantly higher than normal on the first postoperative day (after small-colon resection and anastomoses, WBC = 130,350 +/- 23,310 cells/microliters,...
Palmer SE, Passmore JL.Thirty-nine unilateral cryptorchid horses were castrated, using a midline scrotal ablation technique. This approach was satisfactory to access both inguinal rings, to eliminate the need for 2 incisions, and to allow for completion of the surgery by primary closure. These horses recovered from surgery with few complications, returned to work promptly, and had excellent cosmetic results.
Rahmani Shahraki A, Raisi A.One of the reasons of weight loss and poor performance in horses is decrease in food intake. Oral cavity problems can cause malfunctions in prehension and deglutition resulting in dysphagia. There are few published reports about a metallic foreign body disorders in the oral cavity of horses due to an important role of their flexible lip and incisor teeth in food selection and prehension. This report describes the history, clinical, hematological and radiographic findings and surgical management of a left oral wall fistula formation due to a piece of wire penetration in a pregnant mare. The wir...
Auer JA, Watkins JP.In recent years fracture fixation in the horse has changed significantly. New devices, mainly adapted from the human field, have been successfully introduced into large animal surgery. Examples of such implants include the DCS/DHS implant system, the self-tapping screw, the cannulated screw, and the pinless external fixator. However, new devices have also been developed exclusively for equine fracture management, including the interlocking intramedullary nail and the external skeletal fixation device. With these devices the surgeon has more options for repairing fractures in horses. Neverthele...
Stolk PW, de Waal Malefijt MC, Buma P, Barneveld A.In this paper the successful replacement of an equine metatarsophalangeal joint by a human total condylar knee prosthesis is reported. In the period of observation following implantation of the endoprosthesis the experimental animal showed almost no lameness when exercised at walk, bearing weight on the operated limb. Flexion and extension of the joint were markedly reduced. The clinical and histological observations clearly support further investigation into the equine metatarsophalangeal joint replacement by an endoprosthesis.
Greet TR.The case histories of three young thoroughbred racehorses with displaced lateral condylar fractures combined with an axial fracture of the lateral sesamoid bone are described. In two cases the condylar fracture was repaired surgically but both horses developed severe degenerative joint disease and remained lame. The third horse was destroyed humanely. It is important that axial fractures of the sesamoid bone are recognised so that a poorer prognosis can be given for treatment of condylar fractures in racing thoroughbreds.
Barrett EJ, Munsterman AS, Hanson RR.To determine the effect of an abdominal support wrap and transrectal abdominal palpation on intra-abdominal pressures (IAPs) measured directly from the peritoneal space. Methods: Prospective, experimental study. Methods: A university-based equine research facility. Methods: Ten healthy adult horses, 5 males and 5 females. Methods: IAPs were measured through an intraperitoneal cannula zeroed at a height midway between the height of the tuber ishii and point of the shoulder. Triplicate measurements were obtained at rest, during transrectal palpation, after placement of an abdominal support wrap,...
Clem MF, DeBowes RM, Yovich JV, Douglass JP, Bennett SM.Sixty-eight cases of cortical bone sequestration in 67 equine patients were reviewed with regard to the clinical presentation, method of treatment, and outcome. All lesions were located in skeletal areas with minimal soft tissue coverage, with 53% of them in the metatarsal and metacarpal bones. At the time of admission, 60% of the patients with limb lesions were lame; the majority improved with therapy. After sequestrectomy, there was a trend for surgical wounds which could be managed by primary closure to heal more rapidly (3.8 weeks) than wounds which required second intention healing (6.4 w...
Claes A, Ball BA, Brown JA, Kass PH.To identify risk factors for rectal tears in horses; assess the effect of initiating cause on tear location, size, and distance from anus; and determine short-term survival rate among horses with various grades of rectal tears. Methods: Retrospective case series. Methods: 99 horses. Methods: Medical records for horses with a rectal tear were reviewed, and data including age; sex; breed; cause, location, and size of the tear and its distance from the anus; tear grade; treatment; and outcome (short-term survival [ie, survival to discharge from the hospital] vs non-survival) were recorded. Data f...
Miyakoshi D, Higuchi T, Ikeda H, Sato M, Yoshimura S.To report a surgical technique and an outcome for the repair of a displaced, transverse scapular body fracture with locking compression plates (LCPs) in a colt. Methods: One 5 month old Thoroughbred colt. Methods: Case report. Methods: A colt sustained an unstable, comminuted, transverse fracture of the scapular body. Three 4.5/5.0 mm LCPs were used with 6.5 mm cancellous screws, 4.5 mm cortex screws, and 5.0 mm locking head screws. Implants were removed 2 months after surgery. Results: Surgical site infection was identified by purulent discharge at the distal aspect of the suture li...
Dowling BA, Dart AJ, Hodgson DR.A 2-week-old Miniature Horse foal was referred for evaluation and treatment of a luxated right tarsometatarsal joint. Treatment consisted of closed reduction and internal fixation using two partially threaded Steinmann pins placed in normograde fashion through the tuber calcis into the proximal third metatarsus. Traumatic luxation has been reported to occur in the tarsocrural, proximal intertarsal and tarsometatarsal joints within the equine tarsus. Treatment for luxation of the distal intertarsal joint has not been documented. The treatment method most commonly suggested for tarsal luxation i...
de Souza Garcia AF, Ribeiro G, de Assis Arantes J, Reginato GM, Xavier NV, Carregaro AB, Silva TJF, Grigoletto R, de Freitas SH, Dória RGS.For horses requiring prolonged daily cephalic intravenous regional limb perfusion (IVRLP), the use of a totally implantable catheter (TIC) could be indicated to reduce complications associated with frequent venipuncture or external catheterization. This study aims to evaluate the implantation technique of the TIC in the cephalic vein of horses for IVRLP, describe the complications associated with the device's placement and use, and assess its viability up to 60 days after implantation. Totally implantable catheters, cut to 15 cm (n = 5) and 46 cm (n = 5) in length, were implanted...
Wilson DG, Trent AM, Crawford WH.A surgical approach to the ramus of the mandible was developed. Subperiosteal elevation of the masseter muscle from the ramus allowed reduction and plate fixation of ramus fractures in a bull and a horse. Results of follow-up examinations, 2 years after surgery, showed excellent functional and cosmetic results.
