Deep digital flexor tenotomy and Distal Phalanx realignment for the treatment of Chronic Laminitis in horses: a literature review

Abstract

Laminitis is the second most common cause of death from disease in horses and causes great suffering in the animal and economic and emotional losses for the people involved. Several therapeutic modalities are used in the treatment of this disease, but their results are not consistently described in the literature. In this scenario, deep digital flexor (DDF) tenotomy is a therapeutic modality that can be used for the treatment of chronic laminitis, releasing the traction force that the DDF tendon exerts on the distal phalanx, which helps with realignment of the latter. The objective of this study was to address the important factors of DDF tenotomy and distal phalanx realignment for the treatment of horses with chronic laminitis. The results of the above analysis suggest that DDF tenotomy and realignment of the distal phalanx is a therapeutic option that should be learned by veterinarians and that it can produce benefits to horses with chronic laminitis.

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

“…Damage to the lateral palmar nerve during the procedure could lead to neuroma formation, in addition to loss of lateral sensation. 10 Sharp transection should minimize the risk of neuroma formation and nerve reattachment is likely to occur, particularly in the case of partial section. 21 Regardless, if any of the structures of the neurovascular bundle are in close contact with the DDFT, hydrodissection could be added to the protocol to prevent injury.…”

“…The use of Doppler mode could also be added to facilitate identification. Damage to the lateral palmar nerve during the procedure could lead to neuroma formation, in addition to loss of lateral sensation 10 . Sharp transection should minimize the risk of neuroma formation and nerve reattachment is likely to occur, particularly in the case of partial section 21 .…”

“…4 In contrast, sport prognosis is not a concern when facing a life-threatening disease such as laminitis. 5,6 In laminitis, the traction exerted by the DDFT on the third phalanx can not longer be counterbalanced by the dermal and epidermal lamellae and rotation and/or sinking occurs. 7 Despite still being controversial for some, DDFT tenotomy is recommended when laminitis is uncompensated, as in cases where pasture comfort is unsatisfactory due to progressive rotation and instability of the third phalanx.…”

“…The pastern approach can also be reserved for cases requiring a second DDFT tenotomy. 9,10 At the midmetacarpus, the tendon can either be exposed at the incision level (limb flexion required) or blindly transected with a tenotomy knife or a scalpel. 6 At this level, the most relevant structure that could be damaged iatrogenically, other than the neighboring soft tissues, is the neurovascular bundle that passes in close contact with the dorsal aspect of the DDFT.…”

“…The midmetacarpal technique is commonly preferred as it avoids penetrating the tendon sheath. The pastern approach can also be reserved for cases requiring a second DDFT tenotomy 9,10 . At the midmetacarpus, the tendon can either be exposed at the incision level (limb flexion required) or blindly transected with a tenotomy knife or a scalpel 6 .…”