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Veterinary surgery : VS2023; 52(3); 388-394; doi: 10.1111/vsu.13932

Ex vivo evaluation of a percutaneous thread-transecting technique for desmotomy of normal palmar/plantar annular ligaments in horses.

Abstract: To develop and describe a minimally invasive, ultrasound-guided, percutaneous technique for the desmotomy of equine palmar/plantar annular ligaments (PALs) using a transecting thread. Methods: Ex vivo study. Methods: Twenty-one normal equine distal limb specimens. Methods: Under ultrasonographic guidance, a surgical thread was percutaneously placed around the PAL through 2 skin punctures (proximal and distal) using a 18 gauge spinal needle in equine limbs (11 forelimbs, 10 hindlimbs) with normal PALs. The ligament was transected by a back-and-forth motion of the thread until the loop emerged from the proximal skin puncture site. Each specimen was dissected and assessed for completeness of transection and iatrogenic damage under direct visualization. Descriptive statistics were reported. Results: The PAL was completely transected in 17/21 limbs. The mean duration of the procedure was 16 minutes. Superficial needle puncture or subtle abrasion of the superficial digital flexor tendon was noticed in 4 limbs. No iatrogenic injury to other intrathecal structures was identified. After PAL division, the needle entry and exit points had a mean diameter of 1.2 and 1 mm, respectively. Conclusions: Desmotomy of normal PALs in equine limb specimens was performed effectively using the percutaneous thread-transecting technique with minimal iatrogenic damage to adjacent structures. Conclusions: Information from this study will allow refinement of the technique for use in equine clinical cases either in standing or anesthetized horses.
© 2023 American College of Veterinary Surgeons.
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Publication Date: 2023-01-10 PubMed ID: 36625237DOI: 10.1111/vsu.13932Google Scholar: Lookup
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Summary

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This study presents a new, minimally invasive surgical technique guided by ultrasound for desmotomy, or the cutting of ligaments, in horses. With a focus on the palmar/plantar annular ligaments (PALs), the study reveals the feasibility and effectiveness of this approach with minimal damage to surrounding structures.

Methods

  • The study was conducted ex vivo, meaning the procedure was performed on limbs removed from deceased horses rather than live subjects. This was done to refine and master the technique before applying it to living samples.
  • A total of 21 normal equine distal limb specimens were used, including both forelimbs and hindlimbs.
  • Using ultrasonographic guidance to enhance precision, a surgical thread was inserted through two skin punctures on the limb, encircling the PAL using an 18-gauge spinal needle.
  • The ligament was cut by moving the thread back and forth until the loop emerged from the proximal (closer to the center of the body) skin puncture site.
  • After the procedure, the specimens were dissected and assessed for a complete cut and any unintentional damage caused during the procedure.

Results

  • Successful complete transection of the PAL was achieved in 17 out of the 21 limbs. The average duration of the procedure was around 16 minutes.
  • Subtle abrasion of the superficial digital flexor tendon was noticed in 4 limbs which occurred due to superficial needle puncture. This represents minimal iatrogenic (caused by medical treatment) damage.
  • No unwarranted injury to other structures within the same sheath was identified, confirming the safety of this procedure.
  • Post-procedure, the needle entry and exit points were found to have a mean diameter of 1.2 and 1mm respectively, indicating minimal invasiveness.

Conclusions

  • Overall, the technique of using a percutaneous (through the skin) thread-transecting approach for equine PAL desmotomy was effective, causing minimal damage to the nearby structures in the limb.
  • The results from this study could assist in refining this technique for use in clinical cases with either standing or anesthetized horses. The potential benefits are considerable, particularly considering the minimally invasive nature of the procedure and the reduced risk of collateral damage to surrounding structures.

Cite This Article

APA
De Gasperi D, Guo D, Guo D, Lu Y, Brounts SH. (2023). Ex vivo evaluation of a percutaneous thread-transecting technique for desmotomy of normal palmar/plantar annular ligaments in horses. Vet Surg, 52(3), 388-394. https://doi.org/10.1111/vsu.13932

Publication

Veterinary surgery : VS
ISSN: 1532-950X
NlmUniqueID: 8113214
Country: United States
Language: English
Volume: 52
Issue: 3
Pages: 388-394

Researcher Affiliations

De Gasperi, Diego
  • Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA.
Guo, Danqing
  • BayCare Clinic, Green Bay, Wisconsin, USA.
Guo, Danzhu
  • BayCare Clinic, Green Bay, Wisconsin, USA.
Lu, Yan
  • Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, USA.
Brounts, Sabrina H
  • Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, USA.

MeSH Terms

  • Horses / surgery
  • Animals
  • Horse Diseases / surgery
  • Ligaments / surgery
  • Tendons / surgery
  • Extremities
  • Forelimb / surgery

Grant Funding

  • American College of Veterinary Surgeons Foundation

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Citations

This article has been cited 1 times.
  1. Breen LJ, Stack JD, Gillen AM, Baldwin CM. Needle tenoscopy of the digital flexor tendon sheath in a standing equine cadaver model using a novel approach and guided palmar/plantar annular ligament desmotomy. Vet Surg 2025 Apr;54(3):524-533.
    doi: 10.1111/vsu.14213pubmed: 39911071google scholar: lookup
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