Ex‐vivo evaluation of a percutaneous looped thread desmotomy of the accessory ligament of the deep digital flexor tendon in horses

• Published in: Veterinary surgery Vol. 53; no. 3; pp. 503 - 512
• Main Authors: Orozco Lopez, David, Mochal‐King, Cathleen, Fontenot, Robin, O'Shea, Caitlin M.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01-04-2024; Blackwell Publishing Ltd
• Subjects: Cutting equipment; Horses; Iatrogenesis; Injuries; Ligaments; Limbs; Needles; Population studies; Sawing; Sutures; Tendons
• ISSN: 0161-3499; 1532-950X
• DOI: 10.1111/vsu.14065

Objective
To determine the ability to completely transect the equine accessory ligament of the deep digital flexor tendon (AL‐DDFT) via an ultrasonographically‐guided, percutaneous looped thread desmotomy using FiberWire suture as a cutting device.
Study design
Ex‐vivo study.
Sample population
A total of 24 normal equine distal forelimb specimens.
Methods
Under ultrasonographic guidance, a Jamshidi needle was placed between the suspensory ligament and the AL‐DDFT, and between the AL‐DDFT and the deep digital flexor tendon, through two stab incisions. FiberWire suture was fed through the needle and looped around the AL‐DDFT. Using a sawing motion, the ligament was transected, and the suture exited through the lateral incision. Surgical sites were dissected and assessed for completeness of transection, iatrogenic injuries, and suture remnants. Descriptive statistics were reported.
Results
The procedure met the successful criteria in 18/24 (75%) of the limbs. The median surgical time was 11 min (range 7–25). No suture failure or suture remnants were noted in any of the specimens. Complications included iatrogenic injury to the medial and lateral neurovascular bundles in 4/24 and 1/24 specimens, respectively.
Conclusion
Complete transection of the AL‐DDFT was achieved in 22/24 (92%) of the specimens; however, the neurovascular bundles were injured in 5/24 (21%) of the specimens.
Clinical significance
A percutaneous looped thread desmotomy of the AL‐DDFT can be studied as an alternative technique for use in equine models prior to its clinical use in patients. Additional studies are required to evaluate efficacy and safety in anesthetized or standing horses.