Giorgio Romanelli DMV, Diplomato ECVS Neoplasie vescicali nel cane: cosa cè di nuovo?
MF ECVS Talk
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Transcript of MF ECVS Talk
![Page 1: MF ECVS Talk](https://reader031.fdocuments.net/reader031/viewer/2022022201/58a045361a28ab39648b4e6b/html5/thumbnails/1.jpg)
BEVA 2009
An Alternative Surgical Approach for Complete Removal of the Manica
Flexoria of the Digital Flexor Tendon Sheath
Simon E. Hennessy MVB, Cert AVP (ESO) (ESST), MRCVS
![Page 2: MF ECVS Talk](https://reader031.fdocuments.net/reader031/viewer/2022022201/58a045361a28ab39648b4e6b/html5/thumbnails/2.jpg)
Reasons for performing study
• Uniaxial approaches described• Allow biaxial manipulation
– Lesion debridement• Ensure complete removal and evaluation
![Page 3: MF ECVS Talk](https://reader031.fdocuments.net/reader031/viewer/2022022201/58a045361a28ab39648b4e6b/html5/thumbnails/3.jpg)
Materials and Methods
• Cadaver Study– 15 hindlimbs
• no known DFTS pathology– Develop surgical technique
• Lateral recumbency
• Clinical evaluation
![Page 4: MF ECVS Talk](https://reader031.fdocuments.net/reader031/viewer/2022022201/58a045361a28ab39648b4e6b/html5/thumbnails/4.jpg)
Surgical Approach
PAL
PDAL
SDFT
DDFTMF
MF
Plantarolateral view
Plantaromedial view
![Page 5: MF ECVS Talk](https://reader031.fdocuments.net/reader031/viewer/2022022201/58a045361a28ab39648b4e6b/html5/thumbnails/5.jpg)
Surgical technique
PAL
PDAL
MF
![Page 6: MF ECVS Talk](https://reader031.fdocuments.net/reader031/viewer/2022022201/58a045361a28ab39648b4e6b/html5/thumbnails/6.jpg)
Surgical technique
![Page 7: MF ECVS Talk](https://reader031.fdocuments.net/reader031/viewer/2022022201/58a045361a28ab39648b4e6b/html5/thumbnails/7.jpg)
Proximolateral portal
PAL
PDAL
MF
![Page 8: MF ECVS Talk](https://reader031.fdocuments.net/reader031/viewer/2022022201/58a045361a28ab39648b4e6b/html5/thumbnails/8.jpg)
Surgical technique
Distal Border
Proximal Synovial Reflection
![Page 9: MF ECVS Talk](https://reader031.fdocuments.net/reader031/viewer/2022022201/58a045361a28ab39648b4e6b/html5/thumbnails/9.jpg)
Cadaver Study
• PAL desmotomy not required• Minimal iatrogenic
damage– Superficial tendon
excoriation• Fluid extravasation
![Page 10: MF ECVS Talk](https://reader031.fdocuments.net/reader031/viewer/2022022201/58a045361a28ab39648b4e6b/html5/thumbnails/10.jpg)
Results - Clinical Cases
• 11 clinical cases– Median age of 13 years– 7/11 cases = cob type breeds– Mean lameness of 2/5
• Mean duration of 4 months• At least 50% improvement to DFTS diagnostic analgesia
– All involved hindlimbs• Moderate effusion in 7/11 cases• Distal limb flexion worsened lameness
![Page 11: MF ECVS Talk](https://reader031.fdocuments.net/reader031/viewer/2022022201/58a045361a28ab39648b4e6b/html5/thumbnails/11.jpg)
• Ultrasonography – all cases– 4/11 cases = SDFT
margin irregularity• MRI – 3 cases; ongoing
study validating MRI versus tenoscopy– T2w-FSE transverse
Clinical Cases - Diagnosis
![Page 12: MF ECVS Talk](https://reader031.fdocuments.net/reader031/viewer/2022022201/58a045361a28ab39648b4e6b/html5/thumbnails/12.jpg)
Clinical Cases
• 11 clinical cases– Tear location
• 7/11 tears laterally• 4/11 tears medially
– 8 partial tears• Debridement no longer performed• Marginal longitudinal DDFT
tears (n=2), and SDFT tears (n=2), granuloma (n=2), MF adhesions to DFTS lining (n=1)
– 1/11 = PAL desmotomy
![Page 13: MF ECVS Talk](https://reader031.fdocuments.net/reader031/viewer/2022022201/58a045361a28ab39648b4e6b/html5/thumbnails/13.jpg)
Clinical Cases
• Previous function• Dressage – 5 horses• General riding – 3 horses• Hunter – 1 horse• Showing – 1 horse• Eventing – 1 horse
Follow up 6 months 12 months
Sound 10/11 10/11
Resolution of effusion 10/11 10/11
Return to previous level of work
8/11 10/11
![Page 14: MF ECVS Talk](https://reader031.fdocuments.net/reader031/viewer/2022022201/58a045361a28ab39648b4e6b/html5/thumbnails/14.jpg)
• Biaxial access– Adhesion debridement– Avoidance of
mesotenons – Granuloma removal– Bilateral transection
along the SDFT border– Anchorage of torn side
for transection of opposite attachment
Discussion -Clinical Advantages
![Page 15: MF ECVS Talk](https://reader031.fdocuments.net/reader031/viewer/2022022201/58a045361a28ab39648b4e6b/html5/thumbnails/15.jpg)
• Controlled, repeatable technique
• Variation of portal placement not required
• Consistent MF removal • PAL desmotomy not
consistently required• Further work – Dorsal
recumbency
Conclusion
![Page 16: MF ECVS Talk](https://reader031.fdocuments.net/reader031/viewer/2022022201/58a045361a28ab39648b4e6b/html5/thumbnails/16.jpg)
Acknowledgements
• Dr. Peter Milner• Cathal Tunney - Illustrations