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Lateral plantar nerve: deep branch - neurectomy and fasciotomy

pequis

Introduction

  • Surgical removal of a section of the deep branch of the lateral palmar nerve in the hindlimb to reduce pain; combined with transection of the connective tissue fascia covering the suspensory ligament at this level to decompress the origin of the suspensory ligament.

Uses

Advantages

  • More specific than tibial neurectomy.
  • Minimal risk of exacerbating the desmitis.
  • PSLD is believed to be associated with a compressive compartment syndrome and therefore fasciotomy is better than neurectomy alone.

Disadvantages

  • Cases need to be selected carefully based on conformation and concurrent clinical problems to avoid post-operative complications or a poor outcome.
  • Severely affected degenerate ligaments in older horses may develop further severe breakdown injuries following this surgery, therefore these cases should not be subjected to this procedure.

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

  • Fair.
  • Some controversy exists about the rate of return to soundness after this procedure, with initial reports suggesting up to 100% success rates.
  • In general, most surgeons believe that 65-75% of carefully selected cases will improve to workable soundness.
  • In a recent study, the outcome for horses with a >80% response to analgesia of the deep branch of the lateral plantar nerve and no concurrent orthopedic or conformational problems had a 77.8% return to full athletic function, at their previous level, for more than one year.
  • Prognosis is influenced by careful case selection and is significantly reduced by presence of concurrent sources of pain or orthopedic problems.
  • In a recent study, only 44% of horses undergoing surgery that also had other orthopedic problems, returned to work at their previous level for more than one year.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Dyson S & Murray R (2012) Management of hindlimb proximalsuspensory desmopathy by neurectomy of the deep branch of the lateral plantar nerve and plantar fasciotomy: 155 horses (2003-2008). Equine Vet J 44 (3), 361-367 PubMed.
  • Pauwels F, Schumacher J, Mayhew J & van Sickle D (2009) Neurectomy of the deep branch of the lateral plantar nerve can cause neurogenic atrophy of the muscle fibres in the proximal suspensory ligament (M. interosseous III). Equine Vet J 41 (5), 508-510 PubMed.

Other sources of information

  • Judy C (2009) Surgical Management of Suspensory Ligament Injuries. In: Proc 2009 Annual ACVS Convention. CD ROM. AAEP, Lexington, Kentucky, USA.
  • Kelly G (2007) Results of Neurectomy of the Deep Branch of the Lateral Plantar Nerve for Treatment of Proximal Suspensory Desmitis. In: Proc 16th Annual ECVS Convention. Dublin. pp 130.
  • Bathe A (2006a) Plantar Metatarsal Neurectomy and Fasciotomy for the Treatment of Hindlimb Proximal Suspensory Desmitis. In: Proc 45th BEVA Congress. Birmingham, UK. pp 198-199.
  • Bathe A (2006b) Plantar Metatarsal Neurectomy and Fasciotomy for the Treatment of Hindlimb Proximal Suspensory Desmitis. In: Proc 2006 Annual ACVS Convention. CD ROM. AAEP, Lexington, Kentucky, USA.

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