Comparison of Metzenbaum scissors and Y-shaped fasciotome for deep metatarsal fasciotomy for the treatment of proximal suspensory ligament desmopathy in horses

Vet Surg. 2018 Oct 15. [Epub ahead of print]

OBJECTIVE: To quantitate the iatrogenic injury associated with deep plantar metatarsal fasciotomy performed with Metzenbaum scissors compared with a Y-shaped fasciotome.

STUDY DESIGN: Experimental ex vivo surgical study.

STUDY POPULATION: Cadaveric hind limbs (n = 20) from 10 sound thoroughbred racehorses.

METHODS: A plantar metatarsal fasciotomy was performed, extending from the proximal extent of the deep metatarsal fascia, distally. Hind limbs were randomly assigned to 2 groups, undergoing fasciotomy with straight Metzenbaum scissors (n = 10) or a Y-shaped fasciotome (n = 10). Magnetic resonance imaging was performed before and after surgery to identify the maximal depth of any iatrogenic trauma. Gross examination of the surgical site included measuring the length of the incision in the deep metatarsal fascia and localizing iatrogenic trauma sustained by the plantar aspect of the proximal suspensory ligament (PSL) during the procedure.

RESULTS: Iatrogenic injury to the PSL was identified in 6 of 10 and 9 of 10 specimens prepared with the fasciotome and Metzenbaum scissors, respectively (P = .03), and was most commonly located in the distal third of the fascial incision. Differences between the length of incision (P = .02) and the maximal depth of signal (P = .03) for incisions created with Metzenbaum scissors or a fasciotome were identified.

CONCLUSION: The use of a fasciotome resulted in longer fascial incisions and less severe iatrogenic trauma to the PSL compared with using Metzenbaum scissors.

CLINICAL SIGNIFICANCE: A Y-shaped fasciotome may be the preferred surgical instrument for successful desmopathy of the PSL fasciotomy because a greater release of compartmental pressure is possible through a longer incision with minimal iatrogenic trauma to the underlying PSL.