This study describes a new surgical technique for complete removal of the manica flexoria (MF) of the digital flexor tendon sheath (DFTS) in horses. The technique was developed through a cadaver study and evaluated in 11 clinical cases. It utilizes a lateral recumbency position and proximolateral and plantaromedial portals to allow biaxial manipulation for thorough lesion debridement and ensure complete MF removal. In clinical cases, lameness resolved in all 11 horses within 6-12 months and 8-10 returned to their previous level of work. The technique provides controlled, repeatable access to thoroughly address DFTS pathology while avoiding common complications.
1. 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
2. Reasons for performing study
• Uniaxial approaches described
• Allow biaxial manipulation
– Lesion debridement
• Ensure complete removal and evaluation
3. Materials and Methods
• Cadaver Study
– 15 hindlimbs
• no known DFTS pathology
– Develop surgical technique
• Lateral recumbency
• Clinical evaluation
9. Cadaver Study
• PAL desmotomy not required
• Minimal iatrogenic
damage
– Superficial tendon
excoriation
• Fluid extravasation
10. 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
12. 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
13. 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
14. • 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
15. • Controlled, repeatable
technique
• Variation of portal
placement not required
• Consistent MF removal
• PAL desmotomy not
consistently required
• Further work – Dorsal
recumbency
Conclusion
