mf ecvs talk
TRANSCRIPT
BEVA 2009
An Alternative Surgical Approach for Complete Removal of the Manica
Flexoria of the Digital Flexor Tendon Sheath
Simon E. Hennessy MVB, Cert AVP (ESO) (ESST), MRCVS
Reasons for performing study
• Uniaxial approaches described• Allow biaxial manipulation
– Lesion debridement• Ensure complete removal and evaluation
Materials and Methods
• Cadaver Study– 15 hindlimbs
• no known DFTS pathology– Develop surgical technique
• Lateral recumbency
• Clinical evaluation
Surgical Approach
PAL
PDAL
SDFT
DDFTMF
MF
Plantarolateral view
Plantaromedial view
Surgical technique
PAL
PDAL
MF
Surgical technique
Proximolateral portal
PAL
PDAL
MF
Surgical technique
Distal Border
Proximal Synovial Reflection
Cadaver Study
• PAL desmotomy not required• Minimal iatrogenic
damage– Superficial tendon
excoriation• Fluid extravasation
Results - Clinical Cases
• 11 clinical cases– Median age of 13 years– 7/11 cases = cob type breeds– Mean lameness of 2/5
• Mean duration of 4 months• At least 50% improvement to DFTS diagnostic analgesia
– All involved hindlimbs• Moderate effusion in 7/11 cases• Distal limb flexion worsened lameness
• Ultrasonography – all cases– 4/11 cases = SDFT
margin irregularity• MRI – 3 cases; ongoing
study validating MRI versus tenoscopy– T2w-FSE transverse
Clinical Cases - Diagnosis
Clinical Cases
• 11 clinical cases– Tear location
• 7/11 tears laterally• 4/11 tears medially
– 8 partial tears• Debridement no longer performed• Marginal longitudinal DDFT
tears (n=2), and SDFT tears (n=2), granuloma (n=2), MF adhesions to DFTS lining (n=1)
– 1/11 = PAL desmotomy
Clinical Cases
• Previous function• Dressage – 5 horses• General riding – 3 horses• Hunter – 1 horse• Showing – 1 horse• Eventing – 1 horse
Follow up 6 months 12 months
Sound 10/11 10/11
Resolution of effusion 10/11 10/11
Return to previous level of work
8/11 10/11
• Biaxial access– Adhesion debridement– Avoidance of
mesotenons – Granuloma removal– Bilateral transection
along the SDFT border– Anchorage of torn side
for transection of opposite attachment
Discussion -Clinical Advantages
• Controlled, repeatable technique
• Variation of portal placement not required
• Consistent MF removal • PAL desmotomy not
consistently required• Further work – Dorsal
recumbency
Conclusion
Acknowledgements
• Dr. Peter Milner• Cathal Tunney - Illustrations