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Veterinary surgery : VS2023; doi: 10.1111/vsu.14055

Minimally invasive ultrasound-assisted cutting thread tenotomy of the deep digital flexor tendon in horses: An ex vivo study.

Abstract: To evaluate the feasibility and limitations associated with a minimally invasive ultrasound-assisted cutting thread technique for tenotomy of the deep digital flexor tendon (DDFT) in horses. Methods: Ex vivo study. Methods: Twenty cadaveric forelimbs. Methods: Forelimbs were placed on a jig to mimic a standing semiflexed position and the midmetacarpal region was prepared to perform tenotomy of the DDFT using a percutaneous technique with a cutting thread. For that purpose, the thread was placed percutaneously around the DDFT (first dorsally and then palmarly) with the aid of a curved 20 gauge spinal needle. Tendon palpation/manipulation and ultrasonographic assessment assisted thread placement. Procedure time and skin puncture size were recorded. Limbs were then dissected to evaluate the degree of DDFT transection and the presence of any iatrogenic lesions. Results: The DDFT was completely transected in all cases. Minor lesions of the superficial digital flexor tendon were found in 11/20 limbs and considered clinically irrelevant. However, the neurovascular bundle was damaged in 6/20 limbs (four limbs had nerve damage and two limbs had a nerve and either a palmar artery or vein damaged). The skin puncture hole sizes ranged from undetectable to 5 mm long. The average duration of the procedure was 7 min and 38 s (range: 4 min 56 s to 10 min 19 s). Conclusions: A DDFT tenotomy can be performed reliably with a percutaneous cutting thread technique. However, refinement of the technique is required to minimize iatrogenic damage. Conclusions: The reported technique allows a DDFT tenotomy to be performed in a minimally invasive manner and has the potential to be clinically applicable.
© 2023 American College of Veterinary Surgeons.
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Publication Date: 2023-11-23 PubMed ID: 37997031DOI: 10.1111/vsu.14055Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The research explores a potentially more efficient method for performing tenotomy surgery on horses’ deep digital flexor tendons with minimal invasiveness, using an ultrasound-guided technique and a percutaneous cutting thread. However, the technique needs further development to minimize incidental damage.

Objective and Method of Research

  • The goal of this ex vivo study was to test the efficiency of a new minimally invasive ultrasound-assisted procedure on the Tenotomy of the Deep Digital Flexor Tendon (DDFT) in horses.
  • The methodology involved using twenty cadaveric horse forelimbs, placed in a standing semi-flexed position for the procedure. The midmetacarpal area was prepared for tenotomy using a minimally invasive percutaneous technique with a cutting thread.

Testing Technique

  • The cutting thread was inserted around the DDFT percutaneously, first dorsally then palmarly, with the guidance of a curved 20 gauge spinal needle.
  • Ultrasound detection and physical manipulation aided the placement of the thread. Procedure time and the size of the skin puncture were noted.
  • The limbs were then dissected to assess the extent of the DDFT transection and the occurrence of any accidental (iatrogenic) lesions.

Results of the study

  • All DDFTs were completely transected in every case. There were minor injuries to the superficial digital flexor tendon in 11 out of the 20 limbs, which were considered not clinically significant.
  • However, there were instances of damage to the neurovascular bundle in 6 out of the 20 limbs. Four limbs suffered nerve damage, and two limbs showed evidence of damage to both a nerve and either a palmar artery or vein.
  • The skin puncture hole sizes varied, ranging from undetectable to 5 mm long. Typically, the procedure took around 7 minutes and 38 seconds, with the time range varying from 4 minutes 56 seconds to 10 minutes 19 seconds.

Conclusions

  • The study concluded that a tenotomy of the DDFT can reliably be performed using the percutaneous cutting thread method. However, more refinement of the technique is necessary to reduce incidental harm (iatrogenic damage).
  • The reported method promises a way to complete a DDFT tenotomy in a more minimally invasive manner and holds potential for clinical application.

Cite This Article

APA
Lalanne C, Bonilla AG. (2023). Minimally invasive ultrasound-assisted cutting thread tenotomy of the deep digital flexor tendon in horses: An ex vivo study. Vet Surg. https://doi.org/10.1111/vsu.14055

Publication

Veterinary surgery : VS
ISSN: 1532-950X
NlmUniqueID: 8113214
Country: United States
Language: English

Researcher Affiliations

Lalanne, Camille
  • Department of Clinical Sciences, College of Veterinary Medicine, University of Montreal, Saint Hyacinthe, Q, Canada.
Bonilla, Alvaro G
  • Tennessee Equine Hospital, Thompson's Station, Tennessee, USA.

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