Comparison of Metzenbaum scissors and Y-shaped fasciotome for deep metatarsal fasciotomy for the treatment of proximal suspensory ligament desmopathy in horses.

This study compares the damage caused by Metzenbaum scissors and a Y-shaped fasciotome during a surgical procedure in horses, determining that the Y-shaped fasciotome causes less severe damage.

Objective and Methods

• This research aims to compare the iatrogenic, or inadvertently caused by a physician or surgeon, injury associated with a deep plantar metatarsal fasciotomy using Metzenbaum scissors compared to a Y-shaped fasciotome.
• The study was an experimental ex vivo study using cadaveric hind limbs (n = 20) from 10 healthy thoroughbred racehorses.
• Each horse’s leg was randomly assigned to one of two groups: fasciotomy with Metzenbaum scissors (n = 10) or a Y-shaped fasciotome (n = 10).
• Magnetic resonance imaging (MRI) was performed before and after the surgery to identify the depth of any trauma induced by the surgical procedure.
• The gross examination of the surgical site involved measuring the length of the incision in the deep metatarsal fascia and localizing the iatrogenic trauma inflicted on the plantar aspect of the proximal suspensory ligament (PSL).

Results

• Iatrogenic injury to the PSL was identified in 6 of the 10 cases where a fasciotome was used, compared to 9 of the 10 cases where Metzenbaum scissors were applied.
• Differences between the lengths of the incision and the maximum depth of the signal for incisions created with Metzenbaum scissors or a fasciotome were identified.

Conclusions

• The use of a Y-shaped fasciotome resulted in longer fascial incisions but less severe iatrogenic damage to the PSL compared to the use of Metzenbaum scissors.
• Based on the findings, the Y-shaped fasciotome is considered a preferred surgical instrument for successful desmopathy of the PSL fasciotomy, as it allows for a greater release of compartmental pressure through a more extended incision with minimal trauma to the underlying PSL.