Effect of Presurgical Iodine-Based Disinfection on Bacterial Colonization of the Equine Peripodal Region.

OBJECTIVE: To compare bacterial colonization after diluted iodine tincture or povidone iodine solution for presurgical disinfection of the equine peripodal region. STUDY DESIGN: Complete block design. ANIMALS: Five horses. METHODS: Disinfection protocols using iodine tincture or povidone iodine solutions were tested on 5 pairs (n = 10) equine front feet. Iodine tincture was applied to the left feet and povidone iodine to the right feet. Fixed surfaces of the sole, frog, hoof wall, and peripodal skin were swabbed pre-preparation (T0), after a standard pre-disinfection step (T1), after short disinfection with a 4-minute application of 0.5% iodine tincture or povidone iodine (T2), and after long disinfection with 12-hour soaking in 0.25% iodine tincture or povidone iodine (T3). Quantitative bacteriology was performed on each swab. RESULTS: The frog and sole were the most contaminated sites compared to hoof wall and skin at T0. Bacterial counts were significantly decreased at T2 for both solutions. Bacterial counts did not change significantly with iodine tincture at T3 but increased with povidone iodine compared to T2. Skin abrasions were detected on almost all feet but were subjectively more severe on iodine tincture-treated feet. CONCLUSION: Soaking for 12 hours with either iodine tincture or povidone iodine is not recommended as these solutions damaged the skin and bacterial recolonization was noted with povidone iodine. Four-minute disinfection using either iodine tincture or povidone iodine (0.5% available iodine) is appropriate for presurgical preparation of the equine peripodal region.

Treatment of epiglottic entrapment by transnasal axial division in standing sedated horses using a shielded hook bistoury.

OBJECTIVES: To report use of a shielded hook bistoury developed for correction of epiglottic fold entrapment in standing sedated horses. STUDY DESIGN: Prospective clinical study. ANIMALS: Standardbreds (n=8), 3-19 years of age. METHODS: Epiglottic fold entrapment was corrected during standing sedation using a shielded hook bistoury passed nasally into the pharynx. Owners, trainers, and referring veterinarians were contacted by telephone to establish outcome. RESULTS: Axial division of the entrapping epiglottic fold was successful in all horses. No short- or long-term complications occurred. Axial transection of the entrapping fold was performed rapidly (mean, 83 seconds between advancing the bistoury into the pharynx and transection of the entrapping fold). CONCLUSION: Transnasal axial division of the aryepiglottic fold can be accomplished safely using the shielded hook bistoury. The shield mechanism minimizes the risk of injury from the cutting blade to adjacent structures.

Palatal sclerotherapy for the treatment of intermittent dorsal displacement of the soft palate in 51 standardbred racehorses.

This retrospective study evaluated the efficacy and side effects of palatal sclerotherapy in standardbred racehorses suspected to have intermittent dorsal displacement of the soft palate (IDDSP). Fifty-one horses were treated with multiple endoscopically guided injections of 3% sodium tetradecyl sulfate in the soft palate. Two groups were identified: those that had respiratory noises during exercise (n = 27) and those that did not (n = 24). Treatment was well-tolerated. Furthermore, horses significantly reduced their racing times for the last 400 m compared with their times before treatment and even when their times were compared to the mean times for horses in the same race. In conclusion, palatal sclerotherapy appears to be a suitable alternative therapeutic option for horses suspected to have IDDSP.

Electrosurgical tenoscopic desmotomy of the accessory ligament of the superficial digital flexor muscle (proximal check ligament) in horses.

OBJECTIVE: To report a tenoscopic technique using monopolar electrosurgery to transect the accessory ligament of superficial digital flexor muscle (AL-SDFM) and outcome in 33 horses. STUDY DESIGN: Case series. ANIMALS: Horses (n=33). METHODS: Medical files and surgery video recordings of horses that had AL-SDFM desmotomy performed by tenoscopy with monopolar electrosurgical electrodes were reviewed. RESULTS: Of 33 horses, 24 were Standardbred racehorses with surgery performed bilaterally for superficial digital flexor tendonitis and 9 horses had flexural deformity. Severe (n=6) and mild (6) intrathecal hemorrhage was the most common intraoperative complication. Large intrathecal vessels including the nutrient artery were successfully electrocoagulated and AL-SDFM transection was completed. Clear/serosanguinous drainage from skin incisions was observed for 4.3±3.3 days (mean, SD). Protracted wound drainage for >4 days occurred in 10 horses, principally in the group treated for flexural deformities (P=.01). CONCLUSIONS: Sixty-four AL-SDFM were transected under tenoscopic observation using monopolar electrodes. Electrocoagulation of large intrathecal vessels, including the nutrient artery, was possible in all cases and allowed completion of desmotomy. Postoperative wound care was similar to routine tenoscopy in most (70%) horses. Aseptic protracted wound drainage was observed in 30% of horses (principally those with flexural deformity), and led to a prolonged hospitalization.

Thoracoscopic lung biopsies in heaves-affected horses using a bipolar tissue sealing system.

OBJECTIVE: To validate the use of the LigaSure™ Vessel Sealing System (LVSS) to perform thoracoscopic lung tissue biopsies in heaves-affected horses. STUDY DESIGN: Prospective clinical study. ANIMALS: Heaves-affected horses (n=12). METHODS: Lung biopsies (n=34) were collected with the LVSS (2-4 biopsies/horse) in horses with and without clinical signs of heaves. Thoracoscope (13th intercostal space [ICS]) and 2 instruments (between the 12-15th ICS) portals were used. Selected clinical and arterial blood gas variables were monitored. Postoperative pneumothorax was evaluated. Depth of thermal injury to the surrounding tissue and representativeness of the biopsies were determined. RESULTS: Mean surgical time was 22.9±8.0 minutes. The complication rate was 5.6%, and primarily related to a focal inadequate sealing of the biopsy margin. Five horses in exacerbation required intraoperative intranasal O(2) . Mean PaO(2) was significantly lower in heaves-affected horses with clinical signs compared with those without clinical signs. Postoperative pneumothorax was detected radiographically after 20 of the 34 procedures. One horse with clinical signs of heaves developed a fatal tension pneumothorax 5 days postoperatively despite close radiographic monitoring. CONCLUSION: Thoracoscopic lung biopsy using LVSS is a rapid and effective technique to harvest peripheral lung tissues from heaves-affected horses. Although the complication rate was tolerable, tension pneumothorax was a potential life-threatening complication because of incomplete lung sealing. CLINICAL RELEVANCE: LVSS can be used with relative safety to perform thoracoscopic lung biopsy, but close postoperative monitoring is necessary to avoid tension pneumothorax.

Histological and biomechanical effects of palatal sclerotherapy in the horse using sodium tetradecyl sulfate.

Palatal sclerotherapy using sodium tetradecyl sulfate has been suggested as a treatment for dorsal displacement of the soft palate in young Standardbred horses. The present study evaluated histological and biomechanical changes in the equine soft palate following trans-endoscopic treatment with a low dose of this compound. Two horses were euthanased and examined at 2 weeks and at 1, 2, 4 and 6 months post-sclerotherapy, while two further horses served as untreated controls. The technique was easily performed in all cases without major complications. On histological examination there was no evidence of palatal necrosis, inflammation or fibrosis in any of the treated or control animals. There was no variation in the density of palatal connective tissue between individuals, and on biomechanical assessment no significant difference in the stiffness of the palatal tissue was found between treated and control horses at any time. The lower dose of sodium tetradecyl sulfate used in this study relative to previous reports, might explain the absence of tissue alterations. This method of sclerotherapy did not alter the morphology or biomechanical properties of normal equine soft palates.

Palatal sclerotherapy: a potentially useful treatment of intermittent dorsal displacement of the soft palate in juvenile standardbred racehorses.

This study was aimed at evaluating the tolerability and the efficacy of palatal sclerotherapy in juvenile standardbred racehorses with easily audible "snoring-like" respiratory noises suspected to be the result of intermittent dorsal displacement of the soft palate. The palate of 8 horses was injected with sodium tetradecyl sulfate under videoendoscopic guidance. Palatal sclerotherapy resulted in resolution of the respiratory noise in 7 horses, improvement of performance in 6 horses, and mild side effects in only 3 horses. This preliminary study suggests that palatal sclerotherapy is a safe, repeatable, inexpensive, and promising technique that should be considered as an alternative to existing treatments of intermittent dorsal displacement of the soft palate.

Evaluation of a thoracoscopic technique using ligating loops to obtain large lung biopsies in standing healthy and heaves-affected horses.

OBJECTIVE: To evaluate use of pre-tied ligating loop to perform thoracoscopic, large lung biopsy in normal and heaves-affected horses. STUDY DESIGN: Prospective clinical study. ANIMALS: Normal (n=5) and heaves-affected (n=6) horses. METHODS: Lung biopsies, 1 from each hemithorax, were collected thoracoscopically using a pre-tied ligating loop. Horses were either normal (C) or heaves-affected with the latter being in remission (Ha) for the initial biopsy and in exacerbation (Hs) for the 2nd biopsy. Clinical variables, PaO(2), and PaCO(2) were used to determine the effect of surgical biopsy. Postoperative pneumothorax was monitored by serial thoracic radiographic examinations. RESULTS: Thoracoscopic lung biopsy (n=29, 22 procedures) was well tolerated by all horses. Complication rate was 31%, including 8 ligature slippage and 1 pulmonary hemorrhage. Intranasal oxygen was administered intraoperatively to 6 horses (2 C, 1 Ha, 3 Hs) with severe hypoxemia or labored breathing. There was a significant decrease in PaO(2) during surgery in horses not supplemented with oxygen. Postoperative pneumothorax (21/22 procedures) detected radiographically resolved within 3 weeks. CONCLUSION: Thoracoscopic lung biopsy using pre-tied ligating loops was minimally invasive, relatively inexpensive, and fairly efficient. Heaves-affected horses tolerated the surgery well, even when in exacerbation; however, the technique was associated with non life-threatening complications in 31% of the biopsies, most of which required correction with additional ligating loops or more sophisticated instrumentation. CLINICAL RELEVANCE: Using laparoscopic pre-tied ligating loop for thoracoscopically-assisted lung biopsy can be considered in horses with normal and impaired lung function but alternative instrumentation and access to intranasal oxygen must be available to the surgeon in case of complications.

Laparoscopic intestinal exploration and full-thickness intestinal biopsy in standing horses: a pilot study.

OBJECTIVE: To assess a laparoscopic technique for equine intestinal biopsy. STUDY DESIGN: Experimental study. ANIMALS: Seven adult horses. METHODS: Food but not water was withheld for 36 hours before laparoscopy. In 3 horses (group A) standing, right laparoscopic access to different small intestinal segments was compared with ventral median celiotomy access. Inaccessible segments were identified at necropsy. In 4 horses (group B), the feasibility of obtaining full-thickness duodenal and cecal biopsies and any associated morbidity were evaluated. Biopsy specimens were collected during standing right laparoscopy using a 2-step procedure and intracorporeal suturing technique, and abdominal lavage was performed. Horses were monitored clinically and by abdominal fluid cytology and microbial culture, and repeat laparoscopy was performed on day 6. RESULTS: Standing right flank laparoscopy provided good observation of small intestinal segments and enabled manipulation of all but 15-20 cm of the duodenum and approximately 40 cm more ileum compared with ventral median celiotomy. Group B horses had no complications, no adhesions, and no bacterial growth from peritoneal fluid samples. None of the horses had signs of abdominal pain. CONCLUSION: A 2-stage intestinal biopsy technique performed during standing, right flank laparoscopy may be a safe alternative to exploratory celiotomy and biopsy in normal horses. CLINICAL RELEVANCE: Right flank laparoscopy allows biopsy of intestinal segments including duodenum and 50% more of the ileum than is accessible by ventral median celiotomy. This technique should be evaluated in clinical patients.

Arthroscopic removal of axial osteochondral fragments of the proximoplantar aspect of the proximal phalanx using electrocautery probes in 23 standardbred racehorses.

OBJECTIVES: To describe the outcome after arthroscopic electrosurgical excision of axial osteochondral (OC) fragments of the proximal plantar aspect of the 1st phalanx (P1) in horses. STUDY DESIGN: Retrospective study. POPULATION: Twenty-three Standardbred racehorses. METHODS: Medical records of Standardbred racehorses that had arthroscopic dissection of axial OC fragments of the proximal plantar aspect of P1 with electrocautery probes were reviewed. Horses were positioned in dorsal recumbency; a 1.5% glycine solution was used to maintain joint distension. The arthroscope portal was in the proximal plantar joint pouch and OC fragments were approached using either an ipsilateral or a contralateral triangulation technique. Dissection of the fibrous attachments was performed using loop and hook electrocautery probes. Follow-up was obtained by telephone questionnaire of owners or trainers and examination of race summary records. RESULTS: Thirty-three axial OC fragments were removed from 28 metatarsophalangeal joints (left, 14; right, 14). No major operative or postoperative complications occurred. Seven of 8 (79%) of horses that raced before surgery raced after surgery. Thirty-six percent (n=4) of horses that had not raced before surgery raced after surgery. CONCLUSION: Intra-articular electrosurgery is a safe, easy alternative to conventional excision of axial OC fragments of the proximal plantar aspect of P1. CLINICAL RELEVANCE: Arthroscopic excision using electrocautery probes is a valid alternate method for removal of axial OC fragments of the proximal plantar aspect of P1. In addition, the dorsal recumbency position facilitates removal of several fragments and multiple joint surgery.