Neurectomy: technique, surgical considerations and complications

Neurectomy of the deep branch of the lateral palmar nerve (DBLPaN)

The DBLPaN neurectomy procedure is performed with the horse in dorsal recumbency under general anaesthesia with the affected limb(s) extended. Following routine aseptic preparation and draping a 5cm long incision is made adjacent to the lateral border of the superficial digital flexor tendon from the level of the distal edge of the accessory carpal bone to just below the head of the fourth metacarpal bone. At this site a thick fascia lies immediately deep to the skin. That fascia is punctured with a scalpel blade before the incision is carefully extended with scissors, mindful of the underlying neurovascular bundle. The lateral palmar nerve and palmar vein lie deep to the thick fascia and the DBLPaN is located deep to both structures. The DBLPaN is smaller than the parent nerve and should course from the palmar nerve in a dorsodistal direction. The DBLPaN is isolated with a spey hook and soaked in 5ml mepivicaine hydrochloride. After 3 minutes the DBLPaN is grasped with Halstead mosquito forceps and as long a portion of nerve as possible (approximately 10mm) is removed using a sharp guillotine technique. The thick fascia is closed with 3 metric polyglactin 910 and the skin is closed with 3 metric polyglaction 910 subdermal sutures and skin staples. A dressing is applied for recovery. [...]