Standing Keratoma Removal Surgery

United Kingdom veterinary surgeons described the surgical technique, complication rate and long-term outcome for the standing removal of keratomas in 30 horses over 7 years.

The average age of the patients was 13 years (range from 2 to 23 years). One foot was affected in every case, 77% forefeet, with 63% of the masses in the toe. All but one horse presented with lameness. Ninety days was the average duration and 3/5 (AAEP 0-5 lameness scale) the average severity. About half the horses (57%) showed a deviation or abnormal tissue at the white line, and 33% had a history of recurrent hoof abscesses.

Surgery, which lasted an average of 47 minutes, was performed under standing sedation with nerve blocks at the proximal sesamoids. The technique’s distinctive features were the use of a sterile screw inserted into the overlying hoof wall as a handle to facilitate removal of the keratoma, as well as the preservation of a band or “bridge” of hoof wall distal to the surgical site, when possible, to maintain hoof stability. The surgical defects were packed with calcium alginate dressings and sterile gauze to maintain pressure, and a foot bandage or cast was applied.

Most (73%) of the horses were shod with a heart-bar shoe the day after surgery, and eight horses were shod with a wooden clog shoe held in place with fiberglass cast material. Five horses experienced complications, which resolved with treatment (three had severe lameness, and two developed proud flesh).

Six…