Ex vivo study shows novel, rapid, suture-free tenotomy technique for the equine deep digital flexor tendon.
Authors: De Gasperi, El Azzi, Martins, Brounts
Journal: American journal of veterinary research
Summary
# Editorial Summary: Novel Thread-Transecting Tenotomy for Equine DDFT Surgical tenotomy of the deep digital flexor tendon (DDFT) remains a valuable intervention for certain cases of severe navicular disease and flexural deformity, yet traditional approaches require suturing and extended operative time. De Gasperi and colleagues evaluated a percutaneous thread-transecting technique using ultrasonographic guidance in 39 equine distal limb specimens (22 forelimbs, 17 hindlimbs), whereby a surgical thread is looped around the DDFT via two needle punctures and drawn back-and-forth until transection is complete. The method achieved complete DDFT transection in all specimens with an impressive average procedure time of 8.6 minutes and no requirement for suturing; however, iatrogenic damage to surrounding structures occurred in 17 limbs (44%), with nerve damage—particularly to the communicating branch of the palmar or plantar nerves—being the most frequent complication (15% of cases involved multiple structures). Whilst the speed and suture-free nature of this technique are clinically attractive, the relatively high incidence of collateral damage warrants careful consideration alongside further investigation into whether such injuries carry clinical significance in living animals. Practitioners considering adoption should await data from clinical trials before implementing this approach routinely, particularly given the potential for neurovascular complications that could affect long-term limb function and patient outcome.
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Practical Takeaways
- •This suture-free technique offers a faster alternative to traditional DDFT tenotomy in ex vivo conditions, with complete transection achievable in under 9 minutes
- •Nerve damage risk is significant (44% of cases), particularly to palmar/plantar nerve branches—clinical validation is essential before adopting this technique in live cases
- •The technique requires ultrasound guidance and careful needle placement but avoids post-operative suture management, which may reduce infection risk if safety can be improved
Key Findings
- •Complete DDFT transection was achieved in all 39 specimens using the novel thread-transecting technique
- •Average procedure time was 8.6 minutes with no suturing required
- •Iatrogenic damage to surrounding structures occurred in 44% of limbs (17/39), most commonly to communicating branches of palmar or plantar nerves