Ex vivo evaluation of an alternative technique for resection of the proximal manica flexoria in horses.
Authors: Noguera Cender Andrea, Mählman Kathrin, Lischer Christoph J
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Rupture of the manica flexoria—the fan-shaped structure that stabilises the digital flexor tendons within the carpal canal—presents a surgical challenge, and tenoscopic resection has emerged as a viable treatment option, yet optimal technique remains incompletely defined. Researchers evaluated a systematic six-step resection approach using hook knives and micro scalpels across 36 equine cadaver limbs, with three surgeons of differing experience levels performing the procedure to assess both technical consistency and safety margins. All specimens underwent successful resection with a median operative time of approximately 15 minutes; importantly, no significant differences emerged between experienced and less-experienced surgeons regarding resection symmetry, tissue appearance, or inadvertent damage, though five potentially clinically significant lesions did occur (three involving the arthroscope or deep digital flexor tendon, and two from micro scalpel contact with the DDFT). This work provides strong preliminary evidence that the described technique is reproducible and relatively safe across varying surgical skill sets, warranting progression to clinical trials in live horses presenting with manica flexoria rupture. For practitioners managing these cases, the findings suggest that standardised procedural protocols may help minimise complications whilst reducing the technical learning curve, though vigilance around DDFT protection during scalpel work remains essential.
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Practical Takeaways
- •This tenoscopic resection technique for manica flexoria appears learnable and reproducible across surgeons with varying experience, offering a standardized approach for a previously challenging condition
- •Expect procedure times between 7-44 minutes depending on surgeon experience; the 5 mm risk of collateral DDFT damage with the micro scalpel warrants careful technique refinement before clinical application
- •This cadaver-validated technique provides sufficient evidence to warrant prospective evaluation in live horses with manica flexoria rupture, potentially offering better outcomes than current management options
Key Findings
- •Manica flexoria was successfully resected in all 36 cadaver specimens using the alternative tenoscopic technique with median resection time of 14 minutes 54 seconds
- •19 of 36 resected specimens (53%) achieved symmetric appearance with minimal collateral damage across three surgeons of varying experience levels
- •Five potentially clinically relevant iatrogenic lesions occurred: three from arthroscope contact (scutum and DDFT) and two from micro scalpel DDFT trauma
- •No significant differences in resection quality or iatrogenic injury rates were detected between surgeons with different levels of surgical experience