University of Pennsylvania, New Bolton Center Kennett Square, Pennsylvania
Foot pain is a common cause of forelimb lameness in the horse and palmar digital neurectomy (PDN) is an effective method of controlling pain unresponsive to other therapies. Known complications are recurrence of lameness due to neuroma formation or reinnervation of the distal limb. The main objective of this study was to evaluate outcome in horses undergoing dorsal-to-palmar branch neuroanastomosis following PDN, including success of the neurectomy as determined by resolution of lameness, postoperative complications, and owner satisfaction. We hypothesized that PDN with dorsal-to-palmar branch neuroanastomosis would improve postoperative outcome compared to previously published data. This procedure was performed at two hospitals with similar surgical methods of end-to-end neuroanastomoses of the proximal transected ends of the palmar branch to the dorsal branch of the palmar digital nerve. Client follow-up was obtained to assess outcome and complications. Success was defined as soundness at least one year postoperatively. Success was seen in 66% of horses, with 84% of horses surviving to one year postoperatively. Surgical complications were seen in 22% of horses, while 32% of horses had unresolved lameness. Limitations included the small case number evaluated per hospital and the variability of technique performed between the two hospitals. While human cases of neurorrhaphy result in improvement of neuroma formation, this technique of palmar-to-dorsal branch neuroanastomoses resulted in a higher neuroma formation rate than previous literature has suggested with a guillotine or pull through techniques of PDN. This surgical approach was consistent with previous reports of lameness postoperatively and survival to one year.
