SURGERY

Dr. Rhoads currently performs elective, non-emergency surgeries in horses. Dr. Rhoads has extensive experience in all types of orthopedic and soft tissue surgeries. Most surgeries are performed under general anesthesia, using inhalant anesthetic agents, extensive patient monitoring, and assisted recovery in a special padded room. In some instances, the surgery may be performed in the standing, sedated animal using local anesthesia. Common surgeries performed include:

Arthroscopy: Utilizing small incisions, a small camera is inserted into the joint for assistance in diagnosing intra-articular lesions, removing chips, aiding in joint surface alignment during fracture repair, injection of intra-articular bone cysts, debriding soft tissue lesions, and debriding joint surfaces in cases of infection. Advantages of arthroscopic surgery include the ability to evaluate a large portion of the joint through a small incision which causes less post-operative pain. The same technology can also be used in tendon sheaths and selective bursae.

 

Correction of angular limb deformity: Angular limb deformities are common in foals and are defined as the deviation of the limb from a straight line when viewed from the front (front limbs) or rear (rear limbs). Typical corrective surgeries include periosteal transection and elevation, and/or transphyseal bridging using implants such as surgical screws or screws and wires. These surgical procedures are often used in conjunction with corrective hoof care. The optimum outcome following surgery is time dependent based on the growth potential of the foal and various joints. Therefore early evaluation is advisable so that a long term plan can be made for each individual. Evaluations generally consist of both a visual exam and radiographic exam of the affected joints.

 

Correction of flexural limb deformity: Flexural limb deformities are common in foals to yearlings and are defined as a deviation of the limb from a straight line when viewed from the side. These are often referred as “contracted tendons”. Flexural deformities may be congenital or acquired later in life. Most of the congenital flexural deformities can be corrected using drugs and bandaging/splinting/casting. Acquired flexural limb deformities often require surgical intervention in combination with corrective shoeing. Typical surgical procedures include inferior check ligament desmotomy, superior check ligament desmotomy, or a combination of both. Again the optimal post-operative outcome is time dependent, so early evaluation and intervention is advisable.

 

Fasciotomy and fasciotomy/neurectomy for hind limb proximal suspensory desmitis: Proximal suspensory desmitis is a common cause of lameness in all types of performance horses. The diagnosis is made by diagnostic anesthesia and imaging including ultrasound, radiographs, and occasionally magnetic resonance imaging. The unique anatomy of the proximal suspensory ligament in the rear limb makes it particularly challenging to treat medically, often leading to treatment failure. The proximal suspensory ligament is bordered by bone on 3 sides (cannon bone and splint bones) and by an inelastic connective tissue structure called a retinaculum on the 4th side. This creates an inelastic “canal” for the proximal suspensory to glide through. Also within this canal are blood vessels and nerves that supply this structure. Injury to the proximal suspensory leads to swelling and thickening which can create a compartmental type syndrome because of the inelasticity of these tissues. A similar situation in humans is carpal tunnel syndrome. Surgery is performed to release this retinaculum, thus relieving the pressure on the structure and allowing it to heal appropriately. Depending on the case, this procedure is sometimes combined with cutting the nerve that supplies the proximal suspensory ligament. Often times these procedures are combined with stem cell therapy within the suspensory ligament.

 

Palmar digital neurectomy: This procedure is performed in horses with forelimb foot pain where other forms of medical treatment have failed. During this procedure the nerves supplying the foot are severed. Therefore, prior to the procedure, it must be determined that the horse is a good and safe surgical candidate. The following criteria must be determined prior to surgery: the lameness is abolished by nerve blocks of the palmar digital nerves, and there is no major damage/deterioration of the navicular bone and deep digital flexor tendon. Typically horses undergoing this procedure are at the end of their performance career, in an attempt to salvage 1 or 2 more years of soundness.

 

Ophthalmologic procedures: Many ophthalmologic conditions can be treated with aggressive medical therapy, however, a few will require surgical intervention. Typical surgical procedures include conjunctival transposition or flap, and placement of an amnionic graft. Both of these procedures are performed on a severely ulcerated cornea, where the integrity of the eye is in jeopardy.

 

Fracture repair: Due to advances in surgical technique and implants available, many more fractured bones can be repaired today compared to 10 years ago. Fractures of the long bones are surgical emergencies and immediate medical care and immobilization of the leg are required. Fractures of non-weight bearing portions of the body such as the skull are very amenable to surgical repair, and generally carry a much more favorable prognosis than comparable fractures in the leg.

 

Respiratory surgery: Many disorders of the upper airway can be repaired surgically. Typical clinical signs of respiratory disorders include exercise intolerance and excessive respiratory noise during exercise. Most often, the disorder can be diagnosed with upper airway endoscopy. Surgeries performed include prosthetic laryngoplasty (tie back) and ventriculectomy for laryngeal hemiplegia or roaring, epiglottic entrapment correction, and subepiglottic cyst removal.

 

Other surgical procedures: Mass removal, tenotomy, splint bone removal, sequestrum removal, cryptorchidectomy (retained testicle removal), and cosmetic procedures are also commonly performed.
 

Preparation For Surgery

Horses undergoing elective surgeries can be bathed or cleaned the the day before or day of the surgery. Horses do not need to be held off of food, but should not be fed any grain the morning of surgery. Water can be offered free choice. Generally, horses are dropped off the morning of surgery, and can be picked up later that afternoon. In some cases, the horse may need to remain hospitalized overnight or longer for additional care.