Tenosynoviotomy for sepsis of the digital flexor tendon sheath in 9 horses.
Authors: Mc Nally Turlough P, Slone Donnie E, Hughes Faith E, Lynch Timothy M
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Tenosynoviotomy for Septic Digital Flexor Tendon Sheath Septic digital flexor tendon sheath (DFTS) represents one of equine orthopaedics' most challenging diagnoses, with traditional outcomes often poor. McNally and colleagues presented their experience managing nine horses with DFTS sepsis using tenosynoviotomy, a salvage procedure involving open drainage through a linear incision positioned lateral to the mesotenon, extending from 5 cm proximal to the proximal sesamoid bones to 2 cm distal to the superficial digital flexor tendon bifurcation, with partial tenotomy of the distal lateral superficial digital flexor tendon branch and second-intention healing. Of the seven horses with documented follow-up at one year, five (71%) returned to functional use—three to ridden exercise and two to breeding—whilst two required euthanasia; all owners reported satisfaction with cosmetic outcomes, and postoperative antibiotic courses averaged 23 days (range 11–46 days) with mean hospitalisation of 11 days. For practitioners managing DFTS sepsis where prognosis is otherwise grave, tenosynoviotomy offers a viable salvage option with realistic potential for return to intended use in approximately 70% of cases, though long-term follow-up data remain limited and owner expectations regarding athletic function should be carefully managed preoperatively.
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Practical Takeaways
- •Tenosynoviotomy offers a practical salvage procedure for DFTS sepsis with reasonable functional recovery rates (71% serviceable) — consider for horses where infection has not responded to standard treatment
- •Expect 11-day average hospitalization and 3+ weeks of postoperative antibiotics; plan client communication around 29% mortality/euthanasia rate despite surgery
- •Cosmetic outcome is acceptable to owners, making this suitable for sport and breeding animals where appearance concerns might otherwise limit treatment options
Key Findings
- •Tenosynviotomy with open drainage achieved 71% (5/7) serviceable outcome at 1 year follow-up in horses with digital flexor tendon sheath sepsis
- •Mean surgery time was 32 minutes with mean hospitalization of 11 days and mean postoperative antibiotic therapy of 23 days
- •Of 5 surviving horses, 3 returned to ridden exercise and 2 were suitable for breeding purposes
- •All owners reported satisfaction with cosmetic appearance at the surgical site