Table Of ContentEQUINE
SURGERY
FIFTH EDITION
JÖRG A. AUER, DR MED VET, DR hc, MS, DACVS, DECVS
Professor Emeritus of Surgery
Former Director, Equine Department
Vetsuisse Faculty Zurich
University of Zurich
Zurich, Switzerland
JOHN A. STICK, DVM, DACVS
Professor Emeritus
Department of Large Animal Clinical Sciences
College of Veterinary Medicine;
Chief Operations Officer Emeritus
Veterinary Teaching Hospital
Michigan State University
East Lansing, Michigan
JAN M. KÜMMERLE, DR MED VET, PhD, DECVS
Senior Clinician Equine Surgery Clinic
Equine Department
Vetsuisse Faculty
University of Zurich
Zurich, Switzerland
TIMO PRANGE, DR MED VET, MS, DACVS
Clinical Associate Professor, Equine Surgery
Department of Clinical Sciences
North Carolina State University
Raleigh, North Carolina
3251 Riverport Lane
St. Louis, Missouri 63043
EQUINE SURGERY, FIFTH EDITION ISBN: 978-0-323-48420-6
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Unless otherwise indicated, all line drawings are Copyright © 2019 Matthias Haab.
Images in Chapter 27 © Dean A. Hendrickson, DVM, MS, DACVS.
Notices
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds or experiments described herein.
Because of rapid advances in the medical sciences, in particular, independent verification of
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Previous editions copyrighted 2012, 2006, 1999, and 1992.
Library of Congress Control Number: 2018941059
Senior Content Strategist: Jennifer Flynn-Briggs
Senior Content Development Manager: Ellen Wurm-Cutter
Content Development Specialist: Alexandra York
Publishing Services Manager: Jeff Patterson
Book Production Specialist: Carol O’Connell
Design Direction: Patrick Ferguson
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
The Fifth Edition is dedicated to:
Our coeditors, Jan Kümmerle and Timo Prange, whose contributions have greatly improved
this edition and made it more comprehensive.
Thank you, Jan and Timo.
Matthias Haab, on whose expert illustrations we could count on for the last three editions.
He was always very efficient in producing top quality work in no time.
To Anita and Claudette, our loving wives, who continue to support us with great
appreciation of our chosen profession.
Jörg A. Auer and John A. Stick
Contributors
Monica Aleman, MVZ, PhD, Anthony T. Blikslager, DVM, PhD, Elizabeth J. Davidson, DVM,
DACVIM DACVS DACVS, DACVSMR
Professor, Medicine and Epidemiology Professor of Equine Surgery Associate Professor in Sports Medicine
University of California Department of Clinical Sciences Department of Clinical Studies
Davis, California North Carolina State University New Bolton Center, University of
Raleigh, North Carolina Pennsylvania
Matthew J. Annear, BSc, BVMS,
Kennett Square, Pennsylvania
MS, DACVO Lindsey Boone, DVM, PhD,
Ophthalmologist DACVS-LA Jennifer L. Davis, DVM, PhD,
Animal Referral Hospital, Sydney Assistant Professor of Equine Surgery DACVIM-LA, DACVCP
New South Wales, Australia Clinical Sciences Associate Professor of Clinical
Auburn University Pharmacology
Jörg A. Auer, Dr Med Vet, Dr hc,
Auburn, Alabama Department of Biomedical Sciences and
MS, DACVS, DECVS
Pathobiology
Professor Emeritus of Surgery Larry R. Bramlage, DVM, MS,
Virginia-Maryland College of Veterinary
Former Director, Equine Department DACVS
Medicine
Vetsuisse Faculty Zurich Equine Surgeon
Blacksburg, Virginia
University of Zurich RREH Surgery
Zurich, Switzerland Rood and Riddle Equine Hospital John A. Disegi, BS
Lexington, Kentucky Research and Development Fellow
Jeremy V. Bailey, BVSc, MVetSc,
Materials Development
DACVS James L. Carmalt, MA, VetMB,
DePuy Synthes
Professor of Large Animal Surgery MVetSc, PhD, FRCVS,
West Chester, Pennsylvania
Department of Large Animal Clinical DABVP(Eq), DAVDC(Eq),
Sciences DACVSMR(Eq), DACVS Padraic M. Dixon, MVB, PhD,
Western College of Veterinary Medicine Professor, Equine Surgery DEVDC (Equine), FRCVS
University of Saskatchewan Large Animal Clinical Sciences Professor of Equine Surgery
Saskatoon, Saskatchewan, Canada Western College of Veterinary Medicine Division of Veterinary Clinical Studies
University of Saskatchewan, Saskatoon The University of Edinburgh, Midlothian
Joshua T. Bartoe, DVM, MS,
Saskatchewan, Canada Scotland, United Kingdom
DACVO
Associate Professor–Adjunct Elizabeth A. Carr, DVM, PhD, Bernd Driessen, DVM, PhD,
Small Animal Clinical Sciences DACVIM, DACVECC DACVAA, DECVPT
Michigan State University Associate Professor Professor of Anesthesiology
East Lansing, Michigan; Large Animal Clinical Sciences Clinical Studies–New Bolton Center
Director College of Veterinary Medicine, Michigan University of Pennsylvania
Ophthalmology Services State University Kennett Square, Pennsylvania
MPI Research East Lansing, Michigan
Wei Duan, PhD, MS, BS
Mattawan, Michigan
Heather J. Chalmers, BSc, DVM, Postdoctoral Associate
Michelle Henry Barton, DVM, PhD, Dipl. ACVR Department of Veterinary Clinical Sciences
PhD, DACVIM Associate Professor Louisiana State University
Fuller E. Callaway Endowed Chair Radiology Baton Rouge, Louisiana
Large Animal Medicine Ontario Veterinary College, Guelph
Norm G. Ducharme, DVM, MSc,
University of Georgia Ontario, Canada
DACVS
Athens, Georgia
Jonathan Cheetham, VetMB, PhD, Director of Equine and Farm Animal
Regula Bettschart-Wolfensberger, DipACVS Hospitals
Dr Med Vet, PhD, DECVAA Associate Professor James Law Professor of Surgery
Professor Department of Clinical Sciences Department of Clinical Sciences
Department of Diagnostics and Clinical College of Veterinary Medicine, Cornell College of Veterinary Medicine, Cornell
Services, Section Anesthesiology University University
Vetsuisse Faculty Ithaca, New York Ithaca, New York;
University of Zurich Chief Medical Officer and Staff Surgeon
Vanessa L. Cook, VetMB, PhD,
Zurich, Switzerland Cornell Ruffian Equine Specialists (CRES)
DACVS, DACVECC
Elmont, New York
Andrea S. Bischofberger, Dr Med Associate Professor
Vet, DVM, PhD, DACVS, DECVS Department of Large Animal Clinical Callie Fogle, DVM, DACVS
Senior Clinician Equine Surgery Clinic Sciences Clinical Associate Professor, Equine
Equine Department Michigan State University Surgery
Vetsuisse Faculty East Lansing, Michigan Department of Clinical Sciences
University of Zurich North Carolina State University
Zurich, Switzerland Raleigh, North Carolina
iv
Contributors v
Lisa A. Fortier, DVM, PhD, DACVS Jan F. Hawkins, DVM, DACVS Robert J. MacKay, BVSc (Dist),
James Law Professor of Large Animal Professor of Large Animal Surgery PhD, DACVIM
Surgery Veterinary Clinical Sciences Professor
Clinical Sciences Purdue University Large Animal Clinical Sciences
Cornell University College of Veterinary West Lafayette, Indiana University of Florida
Medicine Gainesville, Florida
Dean A. Hendrickson, DVM, MS,
Ithaca, New York
DACVS Khursheed R. Mama, BVSc, DVM,
Jennifer G. Fowlie, BSc, DVM, MS, Professor of Surgery DACVAA
DACVS Clinical Sciences Professor, Anesthesiology
Moore Equine Veterinary Centre Colorado State University Clinical Sciences
Rocky View County Fort Collins, Colorado Colorado State University
Alberta, Canada Fort Collins, Colorado
Michelle A. Jackson, Dr Med Vet,
Samantha H. Franklin, BVSc, PhD, DECVS, DFVH John F. Marshall, BVMS, PhD,
DACVSMR, MRCVS Senior Clinician Equine Surgery Clinic DACVS, DECVS
Associate Professor in Equine Physiology Equine Department Lecturer in Equine Surgery
School of Animal and Veterinary Science Vetsuisse Faculty School of Veterinary Medicine
University of Adelaide University of Zurich University of Glasgow
Adelaide, Australia Zurich, Switzerland Glasgow, Renfrewshire
David E. Freeman, MVB, PhD, Sherry A. Johnson, DVM Ann Martens, DVM, PhD, DECVS
DACVS Resident, Equine Sports Medicine & Professor of Large Animal Surgery
Appleton Professor of Equine Surgery Rehabilitation Department of Surgery and
Large Animal Clinical Sciences Colorado State University Anaesthesiology of Domestic Animals
University of Florida, College of Orthopaedic Research Center Faculty of Veterinary Medicine, Ghent
Veterinary Medicine Fort Collins, Colorado University
Gainesville, Florida Merelbeke, Belgium
Jessica A. Kidd, BA, DVM, CertES
David D. Frisbie, DVM, PhD, (Orth), DECVS, MRCVS Katharyn Mitchell, BVSc,
DACVS, DACVSMR Surgeon DipVetClinStud, DACVIM
Professor, Clinical Sciences Dr Jessica Kidd Ltd. Clinic for Equine Internal Medicine,
Director of Research Oxford, United Kingdom Equine Department
Orthopedic Research Center Vetsuisse Faculty
Jan M. Kümmerle, Dr Med Vet,
Interim Director of Operations University of Zurich
PhD, DECVS
Translational Medicine Institute Zurich, Switzerland
Senior Clinician Equine Surgery Clinic
Colorado State University
Equine Department Freya M. Mowat, BVSc, PhD,
Fort Collins, Colorado
Vetsuisse Faculty DECVO, DACVO, MRCVS
Susan L. Fubini, DVM, DACVS University of Zurich Assistant Professor, Ophthalmology
Professor Zurich, Switzerland Clinical Sciences
Large Animal Surgery North Carolina State University College of
Christoph J. Lischer, Dr Med Vet,
Cornell University Veterinary Medicine
DECVS
Ithaca, New York Raleigh, North Carolina
Professor
Anton E. Fürst, Dr, DECVS Faculty of Veterinary Medicine Margaret C. Mudge, VMD, DACVS,
Professor Equine Clinic Freie Universität Berlin DACVECC
Equine Department Berlin, Germany Associate Professor of Equine Emergency
Vetsuisse Faculty & Critical Care
Mandi J. Lopez, DVM, MS, PhD,
University of Zurich Veterinary Clinical Sciences
DACVS
Zurich, Switzerland The Ohio State University
Professor and Director
Columbus, Ohio
Mathew P. Gerard, BVSc, PhD, Veterinary Clinical Sciences
DACVS Louisiana State University Amelia S. Munsterman, DVM, MS,
Teaching Professor, Veterinary Anatomy Baton Rouge, Louisiana PhD, DACVS, DACVECC, CVA
Molecular Biomedical Sciences, College of Clinical Assistant Professor
Emma J. Love, BVMS, PhD, DVA,
Veterinary Medicine Surgical Sciences
DECVAA, MRCVS, FHEA
North Carolina State University University of Wisconsin–Madison School
Senior Teaching Fellow in Veterinary
Raleigh, North Carolina of Veterinary Medicine
Anaesthesia
Madison, Wisconsin
Kati G. Glass, DVM, DACVS Bristol Veterinary School
Clinical Assistant Professor in Large University of Bristol Nathan C. Nelson, DVM, MS,
Animal Surgery Langford, United Kingdom DACVR
Large Animal Clinical Sciences Clinical Associate Professor
Joel Lugo, DVM, MS, DACVS
Texas A&M College of Veterinary Medicine Department of Molecular Biomedical
Associate Surgeon
and Biomedical Sciences Sciences
Ocala Equine Hospital
College Station, Texas North Carolina State University
Ocala, Florida
Raleigh, North Carolina
vi Contributors
Frank A. Nickels, DVM, MS, Timo Prange, Dr Med Vet, MS, Michael Schramme, Dr Med Vet,
DACVS DACVS CertEO, PhD, HDR, DECVS,
Professor Clinical Associate Professor, Equine DACVS, Associate ECVDI
Department of Large Animal Clinical Surgery Professor of Equine Surgery and
Sciences Department of Clinical Sciences Orthopaedics
Michigan State University North Carolina State University Département Hippique
East Lansing, Michigan Raleigh, North Carolina VetAgro Sup, University of Lyon, Marcy
L’Etoile
Alan J. Nixon, BVSc, MS, DACVS Patricia J. Provost, VMD, MS,
Rhone-Alpes, France
Professor of Orthopedic Surgery DACVS
Clinical Sciences Surgeon/Associate Veterinarian James Schumacher, DVM, MS,
Cornell University Brown Equine Hospital DACVS
Ithaca, New York; Somerset, Pennsylvania Professor
Chief Medical Officer Department of Large Animal Clinical
Peter C. Rakestraw, VMD, MA,
Cornell Ruffian Equine Specialists Sciences
DACVS
New York, New York University of Tennessee
Consulting Surgeon
Knoxville, Tennessee
Henry O’Neill, MVB, DVM, MS, Korean Racing Authority
DACVS, MRCVS Seoul, South Korea John Schumacher, DVM, MS,
Equine Surgeon DACVIM, DABVP
Dean W. Richardson, DVM,
Donnington Grove Veterinary Surgery, Professor
DACVS
Newbury Clinical Sciences
Charles W. Raker Professor of Surgery
Berkshire, United Kingdom Auburn University
Clinical Studies New Bolton Center
Auburn, Alabama
Kyla F. Ortved, DVM, PhD, University of Pennsylvania
DACVS, DACVSMR Kennett Square, Pennsylvania Ceri Sherlock, BVetMed, MS,
Assistant Professor of Large Animal MVetMed, DACVS-LA,
Simone K. Ringer, Dr Med Vet,
Surgery DECVS-LA, DECVDI-LA
DVM, PhD, DECVAA
Clinical Studies Equine Surgeon and Head of Diagnostic
Department of Diagnostics and Clinical
University of Pennsylvania Imaging
Services, Section Anesthesiology
Kennett Square, Pennsylvania Bell Equine Veterinary Clinic, Mereworth
Vetsuisse Faculty
Kent, United Kingdom
Karine Pader, DVM, MS, University of Zurich
DACVS-LA, DECVS Zurich, Switzerland Roger K. W. Smith, MA, VetMB,
Staff Surgeon PhD, DEO, FHEA, ECVDI
Fabrice Rossignol, DVM, DECVS
La Clinique du Cheval LAAssoc, DECVS, MRCVS
Senior Surgeon
Grenade sur Garonne, France Professor of Equine Orthopaedics
Equine Clinic of Grosbois
Clinical Sciences and Services
Anthony P. Pease, DVM, MS, Boissy Saint Leger, France
The Royal Veterinary College, Hatfield
DACVR
Alan J. Ruggles, DVM, DACVS Hertfordshire, United Kingdom
Chief Veterinary Medical Officer
Staff Surgeon
Veterinary Division Louise L. Southwood, BVSc, PhD,
Surgery Department
Western Veterinary Conference DACVS, DACVECC
Roodand Riddle Equine Hospital
Henderson, Nevada Associate Professor, Large Animal
Lexington, Kentucky
Emergency and Critical Care
John F. Peroni, DVM, MS, DACVS
Lauren V. Schnabel, DVM, PhD, New Bolton Center
Professor
DACVS-LA, DACVSMR-Equine University of Pennsylvania
Large Animal Medicine
Assistant Professor of Equine Orthopedic Kennett Square, Pennsylvania
University of Georgia
Surgery
Athens, Georgia Suzanne Stewart, MVB, DACVS
Department of Clinical Sciences
Research Project Manager
Simon M. Petersen-Jones, Dr Vet North Carolina State University
School of Veterinary Medicine
Med, PhD, DVOphthal, DECVO, Comparative Medicine Institute
University College Dublin
MRCVS Raleigh, North Carolina
Dublin, Ireland
Professor, Comparative Ophthalmology
Angelika Schoster, Dr Med Vet,
Department of Small Animal Clinical Felix Theiss, Dr Med Vet, PhD,
DVSc, PhD, DACVIM, DECEIM
Sciences DECVS
Senior Clinical Lecturer
Michigan State University Senior Clinician Equine Surgery Clinic
Clinic for Equine Internal Medicine
East Lansing, Michigan Equine Department
Equine Department
Vetsuisse Faculty
Kenneth E. Pierce, DVM, MS, Vetsuisse Faculty
University of Zurich
DACVO University of Zurich
Zurich, Switzerland
Associate Zurich, Switzerland
Comparative Ophthalmology Ferenc Tóth, DVM, PhD,
Harold C. Schott II, DVM, PhD,
Veterinary Eye Institute DACVS-LA
DACVIM
Plano, Texas Assistant Professor
Professor
Veterinary Population Medicine
Department of Large Animal Clinical
University of Minnesota
Sciences
St. Paul, Minnesota
Michigan State University
East Lansing, Michigan
Contributors vii
Wendy M. Townsend, DVM, MS, Denis Verwilghen, DVM, MSc, David A. Wilson, DVM, MS,
DACVO PhD, DES, DECVS DACVS
Associate Professor, Ophthalmology Head of Equine Services Professor and Hospital Director
Veterinary Clinical Sciences Associate Professor in Equine Surgery Veterinary Medicine & Surgery
Purdue University University Veterinary Teaching Hospital University of Missouri
West Lafayette, Indiana Camden Columbia, Missouri
School of Veterinary Science, Faculty of
P. René van Weeren, DVM, PhD, J. Brett Woodie, DVM, MS, DACVS
Science, University of Sydney, Camden
DECVS Surgeon
New South Wales, Australia
Professor of Equine Musculoskeletal Rood and Riddle Equine Hospital
Biology Jeffrey P. Watkins, DVM, MS, Lexington, Kentucky
Department of Equine Sciences DACVS
Faculty of Veterinary Medicine, Utrecht Professor of Large Animal Surgery
University Veterinary Large Animal Clinical Sciences
Utrecht, Netherlands College of Veterinary Medicine, Texas
A&M University
College Station, Texas
Preface
Our goal for the fifth edition of Equine Surgery was to maintain
New Features
the high standard of the previous edition and continue its position
as the leading worldwide clinical reference and teaching textbook The new features include:
for equine clinicians, practitioners, surgery residents, and students.
We, the senior editors, Jörg and John, continued the format of • Thoroughly revised and updated content with expanded
the last edition by taking direct responsibility for inviting authors coverage on current and new topics throughout the textbook
in the sections for which we were in charge; however, we invited • Addition of 35 videos illustrating knot tying, surgical tech-
co-editors, Jan and Timo, to join us in this and they will take niques, video endoscopic views of surgical anatomy, and correct
over our responsibilities for the next edition. positioning of instruments during surgery
We have continued to focus on the clinically relevant aspects • Expansion of the total content of the book by 20% (now
of equine surgery, presenting information in a concise, understand- more than 1800 pages)
able, and logical format. Extensive use of figures, tables, and • Complete reorganization of the nervous system with four new
cross-referencing within and among sections, help make the fifth chapters, including Chapter 52, Pharmaceutical Considerations
edition of Equine Surgery a quick and easy-to-use reference for Treatment of the Central Nervous System, Chapter 53,
textbook. A new feature is the addition of videos demonstrating Vertebral Column and Spinal Cord, Chapter 54, Neurocranium
a variety of surgical techniques, including knot tying, trocar and Brain, and Chapter 55, Peripheral Nerve Injuries.
placement, and endoscopic evaluations. This feature along with • Reorganization of the alimentary system into upper and lower
the availability of the book in ebook format will provide the segments with four new chapters, including Chapter 32, Spleen
reader with immediate electronic access in a surgical setting. and Liver, Chapter 36, Cecum, Chapter 37, Large Colon, and
Chapter 38, Transverse and Small Colon
• A new chapter (Chapter 97, Humerus) was added to the section
ORGANIZATION
on the musculoskeletal system. Furthermore, information on
The book contains twelve sections, starting with surgical biology, arthroscopic, tenoscopic, and bursoscopic procedures was
surgical methods, recent advances in anesthesia, and an expanded expanded and now covers all relevant techniques
section on minimally invasive surgery, and is followed by sections
pertaining to all organ systems. Each section is logically structured
and supported extensively by illustrations, photographs, tables,
Book Cover
and videos. A comprehensive list of references completes each
chapter. Through all four previous editions we maintained the same
overall style of the book cover, mainly the font and the little
horse on the back and the front cover. The only thing that
KEY FEATURES OF THE FIFTH EDITION
changed was the color of the cover. For the cover of the previ-
We have retained all of the features that were popular in the first ous edition we added a colored drawing by Matthias Haab,
four editions and have significantly updated all chapters in the our illustrator.
fifth edition. We continued to select known and novel contributors For the fifth edition, we chose a photograph of the first bronze
who are recognized as experts in their fields to author the chapters sculpture of a horse created by Jörg Auer (www.joergauer.com),
in this edition. “Follow Me.”
viii
Acknowledgments
First, we would like to express gratitude to our contributors, We would like to extend our sincerest thanks to Penny
without whom this work would not have been possible. Their Rudolph, our motivating, joyful, and very competent publisher
dedication to producing an excellent product has resulted in at Elsevier for initiating this edition, and wish her the very best
another textbook accomplished in a timely fashion so that the in her retirement. Our thanks also go to Jennifer Flynn-Briggs
content will continue to represent current “state-of-the-art” surgical and the rest of her team who aided the process of continuity in
procedures and techniques. So to our contributors, once again, the book.
thank you for the marvelous work. A special thank you goes to Matthias Haab of Zurich, Swit-
Thanks also goes to our co-editors, Jan M. Kümmerle and zerland, who continued to do a marvelous job in preparing all
Timo Prange, whose contributions to this edition are very much the new artwork. Not only is the quality of the artwork outstand-
appreciated. Their attention to detail and addition of new material ing, he did this work with great efficiency, which made the final
have improved this edition so very much. We wish them the product first-rate.
very best as they continue on with the next edition without us.
ix
Video Contents
13.1 Video illustration of how a foggy image can be 16.18 Technique for tying an Aberdeen knot.
resolved. 16.19 Chinese finger trap technique.
13.2 Video explanation of how to perform an 16.20 Use of the skin stapler to close a skin incision.
extracorporeal 4-S modified Roeder slipknot.
32.1 Demonstrating the pathway for laparoscopic approach
13.3 Video demonstration of the technique for transvaginal to the epiploic foramen.
access to the abdominal cavity under endoscopic
32.2 Demonstrating the ideal placement of the
guidance.
gastropancreatic fold against the caudal aspect of the
13.4 Video demonstration of the technique for trocar caudate liver lobe using the Babcock forceps.
exchange.
32.3 Tacking of the gastropancreatic fold.
16.1 One-handed knot typing technique.
48.1 Self-retaining tracheostomy tube insertion.
16.2 Two-handed knot typing technique.
51.1 Vertebral canal endoscopy: cervical myeloscopy and
16.3 Hand-tied sliding knot 1. lumbosacral epiduroscopy.
16.4 Hand-tied sliding knot 2. 55.1 Left femoral nerve paralysis following prolonged
16.5 Instrument-tied simple knot. anesthesia in dorsal recumbency with caudally
16.6 Instrument-tied surgical knot. extended hind limbs.
16.7 Simple continuous suture pattern. 85.1 Typical motion of a horse affected with fibrotic
myopathy of the semitendinosus muscle.
16.8 Cruciate suture pattern.
85.2 Typical motion of a horse with classical stringhalt:
16.9 Vertical mattress suture pattern.
involuntary and exaggerated flexion mainly of the left
16.10 Horizontal mattress suture pattern. hindlimb.
16.11 Ford interlocking suture pattern. 85.3 A horse with rupture of the left peroneus tertius.
16.12 Connell and Cushing suture pattern. 85.4 Typical motion of a horse with a ruptured extensor
16.13 Lembert suture pattern. caripi radialis tendon, first at a walk and then at a trot.
16.14 Pursestring suture pattern. 87.1 A 4-month-old Arabian foal is shown walking toward
the viewer next to its dam. During protraction of each
16.15 Far-near-near-far suture pattern.
fore limb the MCP region describes an outward arch.
16.16 Three-loop pulley suture technique.
16.17 Three-loop pulley suture technique.
xiv
