Desmectomy of a septic accessory ligament of the deep digital flexor tendon in the hindlimb of a horse under standing sedation

Summary

# Editorial Summary A case of septic accessory ligament of the deep digital flexor tendon (ALDDFT) in the hindlimb presented a surgical challenge when systemic antibiotic therapy failed and financial constraints precluded prolonged hospitalisation. The clinicians performed a standing desmectomy under sedation and local analgesia, a novel approach for hindlimb ALDDFT pathology, with histopathology confirming the septic process within the ligament. Remarkably, the horse recovered rapidly, was discharged within 7 days post-operatively, and remained in full work two years later. This case demonstrates that standing surgical techniques traditionally reserved for forelimb conditions may be viable alternatives for hindlimb accessory ligament disease when conventional treatment fails, and suggests that the ALDDFT—a structure previously unreported as a source of infection in the hindlimb—warrants consideration in differential diagnoses of discharging wounds over the metatarsal region. For practitioners managing septic flexor tendon apparatus cases, this report challenges the assumption that complex hindlimb infections necessitate general anaesthesia and extended recovery periods, though standing desmectomy remains a specialist procedure requiring appropriate sedation, local analgesia protocols, and surgical expertise.

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Key Findings

• •ALDDFT desmectomy performed successfully under standing sedation and local analgesia in hindlimb septic process
• •Histopathology confirmed septic process within affected accessory ligament
• •Horse achieved rapid recovery and returned to full work 2 years post-operatively

Conditions Studied