Effect of single and double hemitenotomy on equine deep digital flexor tendon length and strength in experimental load challenges.

OBJECTIVE: To evaluate a double hemitenotomy (DHT) technique as an alternative to complete deep digital flexor (DDFT) tenotomy. STUDY DESIGN: Experimental ex vivo study. SAMPLE POPULATION: Isolated DDFTs (n = 30) and cadaveric forelimbs (n = 16). METHODS: In part 1, 15 isolated DDFT pairs were used. Two hemitenotomies were created in 1 DDFT while the other served as reference. Monotonic tensile load was applied. Tendon lengthening, load reduction, and load at failure were recorded. In part 2, 16 cadaveric forelimb pairs were subjected to DHT followed by complete tenotomy (CT) under monotonic compressive load. Differences between DHT and controls were assessed with Wilcoxon signed rank tests or Friedman tests. RESULTS: In isolated tendons and cadaveric forelimbs, DHT resulted in DDFT lengthening (median, +1.9 mm and + 3.05 mm) and load reduction (median, -16.7 and -11.2 kg). Less lengthening was achieved with DHT compared to CT (P = .008). Load reduction did not occur between DHT and CT was observed during compressive testing (P = 1). Load reduction following the first hemitenotomy incision was smaller when compared to the second (P = .022). Isolated DHT tendons failed at a tensile load of 195 kg, while no intact tendons failed (P = .0001). CONCLUSION: Double hemitenotomy was comparable to CT in load reduction. It reduced tensile strength, but load at failure was similar or exceeded the estimated DDFT load at stance. CLINICAL SIGNIFICANCE: Hemitenotomy may be a useful alternative for surgical management of horses with laminitis, but in vivo studies are needed to confirm these findings.

The Effect of Inhaled Albuterol on PaO2 in Anesthetized Horses Receiving a FiO2 of 0.5 or >0.95.

Impairment of oxygen uptake can occur during general anesthesia in horses resulting in hypoxemia. Multiple treatments have been investigated for correction of hypoxemia with varying levels of success. In clinical trials, albuterol, a short-acting ß2 adrenergic agonist, improved arterial oxygen partial pressure (PaO2) in anesthetized horses unresponsive to adjustments in mechanical ventilation and administration of positive inotropic drugs. However, controlled studies comparing the magnitude of change and duration of effect of albuterol on PaO2 in healthy, nonhypoxemic anesthetized horses are lacking. In a prospective study, 14 horses were anesthetized and received a FiO2 of 0.5 (n = 7) or > 0.95 (n = 7). Horses were maintained on isoflurane and mechanically ventilated. After 15 minutes, baseline PaO2 was determined. Within each FiO2 group, five horses were administered inhaled albuterol (2 µg/kg) and two horses received no treatment. At 10, 20, 30, and 40 minutes after baseline, PaO2 was measured. Data for horses that received albuterol were analyzed with repeated measures analysis of variance with significance at P < .05. Horses that received albuterol had an increase in PaO2 for at least 40 minutes after baseline. Albuterol administered via inhalation, was associated with an increased PaO2 of at least 40 minutes compared to baseline in healthy, nonhypoxemic horses undergoing anesthesia at similar depth, using a FiO2 of 0.5 and > 0.95. Side effects were mild and consisted of increased heart rate and sweating. Albuterol administered at 2 µg/kg via inhalation may be useful for increasing PaO2 in anesthetized horses.

Minimally invasive tenotomy of the tibial insertion of the semitendinosus muscle: An ex vivo study in horses.

OBJECTIVE: To describe a minimally invasive technique for semitendinosus tenotomy with ultrasonographic guidance and to evaluate procedural complications. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Cadaveric equine hind limbs (n = 16). METHODS: A stab incision was performed distocaudal to the tibial insertion of the semitendinosus muscle with ultrasonographic assistance. After transection of the tendon with an arthroscopic retrograde knife, the tendon edges palpably retracted, and complete transection was confirmed by ultrasound. Limbs were dissected to confirm the degree of tendon transection and to identify iatrogenic trauma to surrounding soft tissues. RESULTS: Tenotomy was complete in all limbs, resulting in a palpable gap forming between tendon edges. Superficial iatrogenic laceration to the underlying gracilis muscle (n = 2) or gracilis fascia (n = 1) was apparent in 3 of 16 limbs. CONCLUSION: Ultrasound-assisted tenotomy of the tibial insertion of the semitendinosus muscle was reliably performed in a minimally invasive fashion with minor iatrogenic damage. CLINICAL SIGNIFICANCE: Minimally invasive tenotomy of the semitendinosus muscle can be performed with ultrasonographic assistance and should be considered as an alternative technique for surgical management of fibrotic semitendinosus myopathy.

Fibro-Osseous Lesions Of The Craniofacial Complex In Horses: 30 Cases (2001-2019).

OBJECTIVE: To describe the presentation, diagnosis, treatment, and outcome for horses with fibro-osseous lesions of the craniofacial complex. STUDY DESIGN: Retrospective multicenter case series. ANIMALS: Thirty horses evaluated for fibro-osseous lesions of the skull from January 1, 2001 through December 31, 2019 in four centers. METHODS: Medical records were reviewed for signalment, clinical presentation, histological and diagnostic imaging findings, treatment instituted, and outcome. Long-term outcome information was obtained by owner questionnaire or the medical record. RESULTS: Diagnoses included ossifying fibroma in 20 of 30 horses, osteoma in eight of 30 horses, and fibrous dysplasia in two of 30 horses. Twelve of 30 lesions were diagnosed in horses <1 year old, and 20 of 30 lesions originated from the rostral mandible. The most common treatment was rostral mandibulectomy. Recurrence was not reported after complete excision. Incomplete excision was confirmed in eight horses (four ossifying fibromas, three osteomas, and one fibrous dysplasia), and follow-up information was available for seven horses. Recurrence occurred in one horse, while six horses had long-term resolution of clinical signs. Prognosis for survival and return to use was excellent in 23 horses with long-term follow-up. CONCLUSION: Fibro-osseous lesions were uncommon in this multicenter study; they were most commonly diagnosed in young animals and most frequently affected the rostral mandible. Long-term survival was excellent. CLINICAL SIGNIFICANCE: The definitive diagnosis of fibro-osseous lesions of the craniofacial complex in horses is made from results of histopathology and cannot be determined on the basis of clinical presentation alone. Surgical excision is indicated, and prognosis can be favorable even when complete surgical margins are not obtained.

Tensile strength and early healing of self-locking and surgeon's knots.

OBJECTIVE: To compare the biomechanical properties and healing of ventral midline celiotomies (VMC) closed with a self-locking knot combination and forwarder start and Aberdeen end (F-A) vs a traditional knot combination and surgeon's start and end (S-S). STUDY DESIGN: In vivo, experimental. ANIMALS: Twenty-one horses. METHODS: Fourteen horses underwent VMC, which was closed with either an F-A (n = 7) or an S-S (n = 7) knot combination. Incisions were subjectively graded by masked evaluators for dehiscence, edema, and drainage. Biomechanical testing was performed on three abdominal segments, and histology was performed on one segment from each animal after humane euthanasia 10 days post-VMC. The abdominal wall of control horses (n = 7, no celiotomy) was collected for biomechanical testing. RESULTS: Forwarder start and Aberdeen end and S-S horses had less tensile strength compared with control horses (P ≤ .001). No differences were detected between treatment groups for any variable evaluated, including tensile strength (P = .975), location of failure (P = .240), and histologic healing at the knot (P = .600). CONCLUSION: Closure of VMC with self-locking knots resulted in biomechanical and healing features similar to those with a traditional closure technique, with neither restoring the tensile strength of the linea alba. CLINICAL SIGNIFICANCE: Results of this study provide evidence to support a clinical trial to evaluate long-term performance of the F-A self-locking knot closure in horses.

Cell engraftment, vascularization, and inflammation after treatment of equine distal limb wounds with endothelial colony forming cells encapsulated within hydrogel microspheres.

BACKGROUND: Endothelial colony forming cells (ECFCs) may be useful therapeutically in conditions with poor blood supply, such as distal limb wounds in the horse. Encapsulation of ECFCs into injectable hydrogel microspheres may ensure cell survival and cell localization to improve neovascularization and healing. Autologous ECFCs were isolated from 6 horses, labeled with quantum nanodots (QD), and a subset were encapsulated in poly(ethylene) glycol fibrinogen microspheres (PEG-Fb MS). Full-thickness dermal wounds were created on each distal limb and injected with empty PEG-Fb MS, serum, ECFCs, or ECFCs encapsulated into PEG- Fb MS (ECFC/MS). Analysis included wound surface area (WSA), granulation tissue scoring (GS), thermography, collagen density staining, and immunohistochemical staining for endothelial and inflammatory cells. The purpose of this study was to track cell location and evaluate wound vascularization and inflammatory response after injection of ECFC/MS or naked ECFCs in equine distal limb wounds. RESULTS: ECFCs were found near and within newly formed blood vessels up to 3 weeks after injection. ECFC and ECFC/MS groups had the greatest blood vessel quantity at week 1 in the wound periphery. Wounds treated with ECFCs and ECFC/MS had the lowest density of neutrophils and macrophages at week 4. There were no significant effects of ECFC or ECFC/MS treatment on other measured parameters. CONCLUSIONS: Injection of microsphere encapsulated ECFCs was practical for clinical use and well-tolerated. The positive ECFC treatment effects on blood vessel density and wound inflammation warrant further investigation.

Growth and function of equine endothelial colony forming cells labeled with semiconductor quantum dots.

BACKGROUND: Endothelial progenitor cells (EPCs) contribute to neovascularization and vascular repair in vivo and are attractive for clinical use in ischemic disease. Tracking of stem and progenitor cells is essential to determine engraftment after administration. Semiconductor quantum dots (QD) are promising for cell labeling due to their ease of uptake by many cell lines and their continued presence after many cell generations. The purpose of this study was to evaluate function and growth of equine EPCs after QD labeling. Additionally, this study evaluated the duration of QD label retention and mechanisms of QD label loss. RESULTS: Endothelial colony forming cells (ECFCs) from adult horses (N = 3) were employed for this study, with QD labeled and unlabeled ECFCs tested from each horse. Cell proliferation of ECFCs labeled with QD at 20 nM was quantified by comparing the number of cell doublings per day (NCD) and the population doubling time (PDT) in labeled and unlabeled cells. Function of labeled and unlabeled ECFCs was assessed by comparing uptake of acetylated low-density lipoprotein (DiO-Ac-LDL) and tubule formation on growth factor containing matrix. Cell proliferation was not impacted by QD labeling; both NCD (p = 0. 95) and PDT (P = 0. 91) did not differ between unlabeled and QD labeled cells. Function of ECFCs assessed by DiO-Ac-LDL and tubule formation was also not different between unlabeled and QD labeled cells (P = 0. 33 and P = 0. 52, respectively). ECFCs retained their QD labeling over 7 passages with both 5 nM and 20 nM label concentrations. Reduction in label intensity was observed over time, and the mechanism was determined to be cell division. CONCLUSIONS: Equine ECFCs are effectively labeled with QD, and QD concentrations up to 20 nM do not affect cell growth or function. QD label loss is a result of cell division. The use of QD labeling with equine EPCs may be an ideal way to track engraftment of EPCs for in vivo applications.

Encapsulation of Equine Endothelial Colony Forming Cells in Highly Uniform, Injectable Hydrogel Microspheres for Local Cell Delivery.

A common challenge in cell therapy is the inability to routinely maintain survival and localization of injected therapeutic cells. Delivering cells by direct injection increases the flexibility of clinical applications, but may cause low cell viability and retention rates due to the high shear forces in the needle and mechanical wash out. In this study, we encapsulated endothelial colony forming cells (ECFCs) in poly(ethylene glycol)-fibrinogen (PF) hydrogel microspheres using a custom-built microfluidic device; this system supports rapid encapsulation of high cell concentrations (10 million cells per mL) and resulting cell-laden microspheres are highly uniform in shape and size. The encapsulated ECFCs were shown to have >95% viability and continued to rapidly proliferate. Expression of cell markers (von Willebrand factor, CD105, and CD14), the ability to form tubules on basement membrane matrix, and the ability to take up low-density lipoprotein were similar between pre- and post-encapsulated cells. Viability of encapsulated ECFCs was maintained after shear through 18-23-gauge needles. Ex vivo and in vivo cell delivery studies were performed by encapsulating and injecting autologous equine ECFCs subcutaneously into distal limb full-thickness wounds of adult horses. Injected ECFCs were visualized by labeling with fluorescent nanodots before encapsulation. One week after injection, confocal microscopy analysis of biopsies of the leading edges of the wounds showed that the encapsulated ECFCs migrated into the surrounding host tissue indicating successful retention and survival of the delivered ECFCs. Rapid, scalable cell encapsulation into PF microspheres was demonstrated to be practical for use in large animal cell therapy and is a clinically relevant method to maintain cell retention and survival after local injection.

Flexural Deformity of the Distal Interphalangeal Joint.

Flexural deformities in young horses are commonly referred to as contracted tendons, which is a term that is not consistent with what is currently understood about their cause. Flexural deformity of the distal interphalangeal joint can be either congenital (present at birth) or acquired (develop at a later stage of growth typically between 1 and 6 months of age). These 2 manifestations are commonly managed differently depending on the cause, age of onset, severity, duration, complicating factors, and owner expectations. Early recognition and appropriate intervention are essential to ensure that it is not performance limiting.

Use of a Barbed Knotless Suture for Laparoscopic Ablation of the Nephrosplenic Space in 8 Horses.

OBJECTIVE: To evaluate use of a knotless suture for laparoscopic closure of the equine nephrosplenic space. STUDY DESIGN: Experimental in vivo study. ANIMALS: Normal horses without previous history of abdominal surgery (n=8). METHODS: The nephrosplenic space was closed under laparoscopic visualization using a unidirectional, barbed 0 metric absorbable suture (copolymer of glycolic acid and trimethylene carbonate). Intracorporeal suturing of the nephrosplenic space was performed in a cranial-to-caudal direction in a simple continuous fashion. Repeat evaluation was performed laparoscopically in 2 horses and by necropsy in 6 horses. The length of closure was measured and nature of the healed tissue was evaluate grossly. RESULTS: Total surgery time was 65-167 minutes (mean ± SD, 89.6 ± 22.6). Suturing time was 30-65 minutes (40.4 ± 16.3). Second laparoscopy in 2 horses was performed at days 198 and 227. Necropsy was performed at day 69-229 postoperatively (132.7 ± 63.0) in 6 horses. The closure measured 12-14 cm in length (13 ± 1) and consisted of mature fibrous tissue bridging the splenic capsule and the nephrosplenic ligament. No residual suture material was identified grossly in any horses. The procedure was easily performed; extracorporeal suture management to hold it taut was unnecessary since the barbs had excellent purchase in the apposed tissues, and intracorporeal knot tying was not required. CONCLUSION: The barbed knotless suture appears to be a valid alternative to facilitate laparoscopic closure of the nephrosplenic space in normal horses; however, further work is necessary to investigate its suitability in clinically affected horses.

Distal border fragments of the equine navicular bone: association between magnetic resonance imaging characteristics and clinical lameness.

Distal border fragments of the navicular bone are increasingly being detected due to the improved capabilities of magnetic resonance imaging (MRI), but their clinical significance remains unclear. The purpose of this retrospective study was to describe the location, size, and frequency of fragments in a cohort of horses presented for MRI of the foot and to compare MRI findings with severity of lameness. Archived MRI studies and medical records were searched from March 2006 to June 2008. Horses were included if a distal border fragment of the navicular bone was visible in MRI scans. Confidence interval comparisons and linear regression analyses were used to test hypotheses that fragments were associated with lameness and lameness severity was positively correlated with fragment volume and biaxial location. A total of 453 horses (874 limbs) were included. Fragments were identified in 60 horses (13.25%) and 90 limbs (10.3%). Fifty percent of the horses had unilateral fragments and 50% had bilateral fragments. Fragments were located at the lateral (62.2%), medial (8.89%), or medial and lateral (28.9%) angles of the distal border of the navicular bone. There was no increased probability of being categorized as lame if a fragment was present. There was no significant difference in fragment volume across lameness severity categorizations. Confidence intervals indicated a slightly increased probability of being classified as lame if both medial and lateral fragments were present. Findings indicated that distal border fragments of the navicular bone in equine MRI studies are unlikely to be related to existing lameness.

Equine distal limb wounds: new and emerging treatments.

Distal limb wounds occur commonly in horses, and treatment can be frustrating for owners and veterinarians. Caring for these wounds is often very expensive, labor intensive, and prolonged. Many commercial products and clinical techniques have been developed to help treat these wounds. Healing of these wounds depends on many factors. With proper wound evaluation and treatment, affected horses can return to function sooner than in the past.

Uterine torsion in mares.

Uterine torsion typically occurs during mid to late gestation and is estimated to cause 5% to 10% of all equine obstetric emergencies. Clinical signs include abdominal pain that may be mistaken for gastrointestinal distress, parturition, or abortion. Uterine torsion is an emergency for the mare and fetus, and early recognition and intervention are essential to optimizing the chance of survival. This article reviews the etiology, diagnosis, treatment, and prognosis of uterine torsion in mares.

Evaluation of a tenoscopic approach for desmotomy of the accessory ligament of the deep digital flexor tendon in horses.

OBJECTIVE: To develop a tenoscopic approach for desmotomy of the accessory ligament of the deep digital flexor tendon (AL-DDFT) in horses. STUDY DESIGN: Experimental. ANIMALS: Cadaveric forelimbs (n=10) and 4 forelimbs from 2 horses anesthetized for terminal teaching procedures, and 12 forelimbs of 6 experimental horses. METHODS: Saline distention of the carpal flexor sheath facilitated insertion of an arthroscope into the distal medial aspect of the sheath between the AL-DDFT and deep digital flexor tendon (DDFT). Location of an instrument portal on the lateral aspect of the metacarpus was identified with a needle. The lateral aspect of the AL-DDFT was transected and the arthroscope and instrument were switched to transect the remaining fibers on the medial aspect. Cadaveric specimens were dissected for evaluation. Experimental horses were monitored for 30 days postoperatively. RESULTS: Minor complications including incomplete division of the AL-DDFT and shallow incision into the suspensory ligament were observed in some cadaver specimens. The AL-DDFT was completely transected in all experimental horses with no suspensory ligament damage. Mean±SD surgical time (incision to skin closure) was 28.3±11.8 minutes. On ultrasonographic examination, transection of the AL-DDFT was complete in all experimental horses. Minor DDFT fiber disruption was noted in 1 limb during ultrasound examination at day 30. CONCLUSIONS: A tenoscopic approach through the carpal flexor sheath provided adequate access for desmotomy of the AL-DDFT.

Effect of topical application of diclofenac liposomal suspension on experimentally induced subcutaneous inflammation in horses.

OBJECTIVE: To determine whether 1% diclofenac liposomal suspension (DLS) ointment would be absorbed transdermally and attenuate experimentally induced subcutaneous inflammation in horses. ANIMALS: 7 healthy adult horses. PROCEDURE: Inflammation was produced by injecting 1% sterile carrageenan into subcutaneously implanted tissue cages 8 hours before (time -8) and at the time of application of test ointment. A crossover design was used. Horses received 1 of 2 treatments (topically administered control or DLS ointments) during 48 hours of carrageenan-induced subcutaneous inflammation. A single application of test ointment (7.2 g) was applied over each tissue cage (time 0). Samples of transudate and blood were collected at -8, 0, 6, 12, 18, 24, 30, 36, and 48 hours. Plasma and transudate diclofenac concentrations were determined by use of high-performance liquid chromatography. Transudate concentrations of prostaglandin E2 (PGE2) were determined with a competitive enzyme immunoassay. RESULTS: DLS was absorbed transdermally. The highest concentration (mean +/- SEM, 76.2 +/- 29 ng/mL) was detectable in tissue-cage fluid within 18 hours after application. Minimal concentrations of diclofenac were detectable in plasma. Application of DLS significantly decreased transudate concentrations of PGE2 at 6 and 30 hours. Decreases in PGE2 concentration were observed in the DLS group at all collection times. CONCLUSIONS AND CLINICAL RELEVANCE: A single topical application of DLS resulted in concentrations of diclofenac in transudate within 6 hours and significantly attenuated carrageenan-induced local production of PGE2. Results of this study suggest that DLS is readily absorbed transdermally and may be efficacious for reducing subcutaneous inflammation in horses.