ISSN 2398-2977      

Desmectomy: overview

pequis

Introduction

  • Desmectomy involves removing a section of a ligament, as opposed to dividing or sectioning a ligament which is termed desmotomy:
    • ectomy means "surgical removal," from Gk. -ektomia "a cutting out of".
    • otomy means a cutting or to cut from Greek.
  • Desmectomy of the accessory ligament of the deep digital flexor tendon (ALDDFT) is the most frequently reported, although the procedure is not common.
  • Desmectomy is used in chronic or refractory cases of desmitis or cases of ligamentous infection.
  • For desmotomy for treatment of DIP joint flexural deformities in foals   DIP joint: flexural deformity  .
  • Surgery can be performed standing or under general anesthesia (GA).

Uses

  • Indicated for chronic/refractory desmitis or infection within a ligament:
    • Desmitis:
      • Forelimb: refractory or chronic cases of ALDDFT desmitis   Accessory ligament DDFT: desmitis 01 - localized swelling  , cases with adhesions between adjacent structures, or cases with a flexural deformity in adult horses.
      • Hindlimb: can be traumatic or degenerative - indications as for the forelimbs   Accessory ligament DDFT: desmitis 02 - flexural deformity      Accessory ligament DDFT: desmitis 03 - flexural deformity  .
    • Infection   Wound: discharging 01 - ALDDFT    Wound: discharging 02 - ALDDFT    Wound: discharging 03 - ALDDFT      Accessory ligament DDFT: infection 01    Accessory ligament DDFT: infection 02 - unhealthy granulation tissue    Accessory ligament DDFT: infection 03 - intra-operative lavage    Accessory ligament DDFT: infection 04 - debridement    Accessory ligament DDFT: infection 05 - location of Penrose drain placement    Accessory ligament DDFT: infection 06 - incision for Penrose drain    Accessory ligament DDFT: infection 07 - Penrose drain in place    Accessory ligament DDFT: infection 08 - 10 days post-surgery  rare.

Advantages

  • Desmectomy removes a portion of the ligament leaving a larger gap post-operatively between the remaining ligament ends:
    • The cut ends will try to rejoin with scar tissue.
    • This makes rejoining of the cut ends with scar tissue more difficult.
  • In cases of infection, a desmectomy serves to remove and debride the affected tissues.
  • A desmectomy can be used in any situation in which a desmotomy is indicated for the reasons above.
  • Standing surgery: no risk or cost of GA.
  • Surgery under GA: better asepsis and patient compliance.

Disadvantages

  • The procedure may be short-lived or ineffective in some cases.

It is most often ineffective in hindlimb cases in which a flexural deformity already exists.

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

  • Pre-existing flexural deformity caused by desmitis, particularly in the hindlimb, greatly decreases the likelihood of return to soundness and resolution of flexural deformity.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Jorgensen A J, Diaz O S & Reef V B (2008) Ultrasonographic diagnosis - desmitis of the accessory ligament of the deep digital flexor tendon in a hindlimb in a horse. Vet Radiol Ultrasound 49 (3), 303-306 PubMed.
  • Lamas L P, Henson F M D & Kidd J A (2008) Desmectomy of a septic accessory ligament of the deep digital flexor tendon in the hindlimb of a horse under standing sedation. Equine Vet Educ 20 (12), 620-624 VetMedResource.
  • Eliashar E et al (2005) Two clinical manifestations of desmopathy of the accessory ligament of the deep digital flexor tendon in the hindlimb of 23 horses. Equine Vet 37, 495-500 PubMed.
  • Boswell J C & Schramme M C (2000) Desmitis of the accessory ligament of the deep digital flexor tendon in the hindlimb of a horse. Equine Vet Educ 12 (3), 129-132 VetMedResource.

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