Equis ISSN 2398-2977

Deep digital flexor tendon: tenotomy

Contributor(s): Steve Adair, Graham Munroe, Vetstream Ltd, Chris Whitton

Introduction

  • Permits lengthening of flexor unit and thus axial realignment of distal interphalangeal joint.
  • Relieves pain and progression of  laminitis   Foot: laminitis  by decreasing sheering stresses on the lamellae of the dorsal aspect of the hoof capsule   Foot: laminitis - dorsal wall lifting theory  and the pressure of the apex of the distal phalanx on the corium of the sole.
  • There are two commonly used approaches: mid-metacarpal and distal.
  • A modified, minimally invasive, distal approach has also recently been described.

Uses

Advantages

  • Often a salvage procedure in severe and otherwise unresponsive flexural deformities, although can aid development into sound riding horses in some cases.
  • Simple procedure.
  • The mid-metacarpal approach avoids invasion of the tendon sheath.
  • The distal approach results in an increased level of release of the tendon.

Disadvantages

  • Often just a salvage procedure.
  • Causes high levels of post-operative pain which requires prolonged analgesia to control. 
  • Variable response.
  • May result in overextension, subluxation of distal interphalangeal joint.
  • Poor cosmetic result.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Guarded: used to be thought of only as a salvage procedure in chronic laminitis cases only, but is now considered to be a worthwhile treatment for contractural deformities which are unresponsive to other treatments.
  • Initial improvement in 2-3 days.
  • Flexor support of the distal phalanx develops through attachments of the distal tendon ends by 6-8 weeks.
  • Maintenance of a normal hoof-pastern axis should be possible.
  • Tension relief lasts several months.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Eustace R A & Emery S L (2009) Partial coronary epidermectomy (coronary peel), dorsodistal wall fenestration and deep digital flexor tenotomy to treat severe acute founder in a Connemara pony. Equine Vet Educ 21 (2), 91-99 Wiley Online Library.
  • Eliashar E, Schramme M C, Schumacher J, Ikada Y & Smith R K W (2001) Use of bioabsorbable implant for the repair of severed digital flexor tendons in four horses. Vet Rec 148 (16), 506-509 PubMed.
  • Hunt R J, Allen D, Baxter G M, Jackman B R & Parks A H (1991) Mid-metacarpal deep digital flexor tenotomy in the management of refractory laminitis in horses. Vet Surg 20, 15-20 PubMed.

Other sources of information

  • Waguespack R W & Caldwell F (2009)How to Perform a Modified Standing Deep Digital Flexor Tenotomy at the Level of the Proximal Interphalangeal Joint.In:Proc AAEP Congress. pp 230-237.
  • Auer J A (2006)Flexural Limb Deformities - Tenotomy of the Deep Digital Flexor Tendon.In:Equine Surgery.3rd edn. Eds: Auer J A & Stick J A. Saunders, Missouri, USA. pp 1160-1161.
  • Fürst A E & Lischer C J (2006)Surgical Management of Laminitis Tenotomy of the Deep Digital Flexor Tendon.In:Equine Surgery.3rd edn. Eds: Auer J A & Stick J A. Saunders, Missouri, USA. pp 1213-1215.


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