Surgery

Oakham Veterinary Hospital has moved to the cutting edge of equine surgery

Surgery

‘Aided by our collaboration with the University of Nottingham Veterinary School, Oakham Veterinary Hospital has moved to the cutting edge of equine surgery, refining and developing new techniques, as well as improving established ones.'

 

Our surgical suite has three operating areas, all accessed from the induction and recovery boxes via overhead gantries. We have a fully clean theatre for elective sterile procedures under general anaesthesia. This facility has positive pressure ventilation with antibacterial filters and is up to human hospital hygiene standards. The second theatre is designed to be used for colic surgery and contaminated procedures, it is designed to enable horses to be rapidly prepared for emergency surgery under anaesthesia. The third facility is designed for the increasing numbers of procedures carried out under local anaesthesia in the standing horse.

 

Our experienced surgical team is headed by Neal Ashton and Julia Dubuc, their combined experience enabling us to provide the very best treatment for your horses. Anaesthesia is headed by Kate White, using the very latest sophisticated monitoring equipment.

 

At Oakham all procedures are undertaken by Neal and/or Julia as lead surgeon and we always have an experienced theatre nurse scrubbed in to set up the increasingly complex equipment efficiently.

‘At Oakham the emphasis is on outcome, so all aspects of our surgical service are designed to achieve an efficient, high quality procedure, to give your horse the best chance of a full recovery’

‘The emphasis is always on provinding the highest possible standard of care for you and your horse'

  • Orthopaedic Surgery
  • Colic Surgery
  • Upper Airway Surgery
  • Dental / Sinus surgery
  • Ophthalmic Surgery
  • General
  • Gynaecological Surgery
  • Urogenital Surgery
  • Blackthorn Injury in Hunters / Sport Horses

Orthopaedic Surgery

In recent years arthroscopic (key hole) surgery has replaced open joint surgery. There are now almost no joints,Orthopaedic surgery at Oakham bursae and tendon sheaths that cannot be treated endoscopically. Exceptional image quality (now using high definition 40 inch plasma screens), and increasingly sophisticated motorised instrumentation, have greatly improved the accuracy of endoscopic treatment. This has lead to greatly improved outcomes with many septic joints now returning to excercise in less than 4 weeks.

Fracture repair techniques are constantly evolving which has led to an increase in the number that can be successfully repaired. The recent introduction of 'locking plate implants' has improved the structural integrity of plate fixation, leading to improved outcomes on procedures such as pastern arthrodesis.

By combining our advanced imaging techniques with endoscopic surgery we have been able to develop treatments for conditions such as deep flexor tendon tears in the navicular bursa.

Colic Surgery

We see many surgical colic cases per year, and through improved anaesthesia, surgery techniques and post operative medical support, we are now seeing increasingly good success rates.

When this is combined with earlier recognition of the condition by referring vets a high proportion of these cases now have excellent long term prospects. In conjunction with the BHS React to Colic campaign OVH Equine have produced the factsheets below answering many of the questions raised by various aspects of colic.

  1. What is Colic?

  2. Types of Colic

  3. Recognising Colic

  4. Colic - Causes and Prevention

  5. Colic - What to do

  6. Colic - What will happen when the Vet comes

  7. Critical Colic cases

  8. The decision to refer

  9. Colic - Costs and insurance cover

Upper Airway Surgery

We now have very effective surgical techniques for the correction of upper airway obstruction in high performance horses. From the trusty hobday, the established tie-back to the recent tie-forward for soft palate displacement. Laser surgery is also now available enabling many techniques to be carried out endoscopically in the standing horse.

Dental / Sinus surgery

Recent advances in local anaesthetic techniques have enabled us to perform almost all dental extractions and sinus surgeries on the standing horse, reducing cost and complication rates. Further refinement of these techniques has lead to the use of endoscopic, minimally invasive electro surgery on sinuses. The majority of surgical sinus cases can be resolved without the need for general anaesthesia, via small incisions, returning the horse to work in less than a month and near free of blemishes.

Ophthalmic Surgery

By working with human surgery colleagues we are able to offer advance ophthalmic surgery for cataract disease.

We now offer advanced microsurgery techniques to enable repair of the cornea, which in the case of severe trauma and disease, has enabled more cases to retain their eye and vision. We have developed prosthetic techniques for improving the aesthetic appearance of horses following the necessary removal of a badly damaged eye. Further refinement of these techniques has enabled our patients to retain their eye lashes, leaving a very natural appearance and retaining a remarkable awareness on the blind side.

General

Recent advances include laparoscopy (keyhole abdominal surgery) which can be carried out under local anaesthesia whilst standing. A combination of hand assisted laparoscopic techniques have been developed for the investigation of abdominal disease, and the prevention of colic from nephrosplenic entrapment.

Gynaecological Surgery

Almost all gynaecological techniques for correction of conformational problems and repair of foaling injuries are carried out in our standing operating stocks and now result in excellent breeding prospects.

Urogenital Surgery

Endoscopy is now widely used in urogenital surgery. Jim was responsible for the development of modified techniques to improve the outcome in penile cancer cases, which are now available to improve the long-term outcome in this common disease.

Blackthorn Injury in Hunters / Sport Horses

Thorn penetration by blackthorn is a common injury in horses hunting over country with fields separated byBlackthorn Injury hedges containing blackthorn (Prunus spinosa) bushes. This type of injury is treated at Oakham Veterinary Hospital on a regular basis throughout the hunting season due to our proximity to the Leicestershire packs. As a result, we have developed a huge amount of experience and a high level of expertise in the treatment of these injuries.

Which joints are commonly affected?

The thorns tend to penetrate areas of the limbs passing through the hedge as it is jumped. Most commonly the front of the knees(carpii), the front of the fetlocks in both front and hind legs. Thorns and thorn fragments can also be found in other joints (stifle, hock), tendon sheaths, bursas, tendons, ligaments, muscle and simply under the skin. The majority of these sites require careful thorn location with ultrasonography and removal the thorn fragments often requires advanced endoscopic surgical techniques.

Irrespective of the injury site the principle for treatment remains the same; if the thorn material is removed the horse will recover well.

Why do thorns cause so much trouble?

Clinical research undertaken at Oakham suggests that the painful tissue reaction to blackthorn injury is notThorn Fragment caused by infection. In fact, contrary to popular belief among the equine veterinary community, the joint is sterile after a thorn penetration. The substances that make blackthorns black are alkaloids, and this thorn contains more alkaloids than other plants. Our research indicates it is this that causes the severe tissue reactions. When the pain and lameness reduces in cases that are untreated, it is likely that the residual lameness is due to a foreign body reaction to the plant material.

How do we diagnose and treat thorn penetration injuries?

The injury can be divided into 2 simple categories-

  1. Extra-synovial (not into a joint, tendon sheath or bursa)
  2. Intra-synovial (into a joint, tendon sheath or bursa)

1. Extra-synovial

The area affected tends to swell and be hot, 3-12 hours after hunting. Pain is quite variable and can be severe initially but will generally subside. Extra-synovial injuries can be divided into 3 areas

• ‘in and out’ - frequently no thorn material is left in the tissue. In these cases, the initial inflammation will subside spontaneously, irrespective of treatment.

• Subcutaneous - thorns can frequently be felt under the skin and squeezed out between thumb and fore finger, or encouraged to work their own way out by application of a poultice.

• Deep sub fascial - If the thorn has penetrated under the fascial layer, it is unlikely to be able to be removed via its entry hole, as the multiple tissue layer holes will not line up unless the limb is in the exact position that it was when it penetrated.

In all of these cases, high resolution ultrasound is used to identify the thorn. We then use an ultrasound guided technique developed at Oakham, to enable accurate identification and removal with minimal trauma. These techniques are performed under local anaesthesia if possible, but in some cases general anaesthesia is necessary.

Ultrasound ScannerUltrasound Scan

2. Intra-synovial

The horse is usually severely lame within 3 hours of hunting, with heat and swelling of the affected structure. Interestingly the lameness does usually reduce but not resolve over the following 12 hours.

Arthroscopic surgery is used to identify and remove the thorn material and flush the synovial structures. We use specific techniques that we have developed at Oakham. All cases require general anaesthesia.

When treated by the techniques we have developed at Oakham, and once all the thorn debris has been successfully removed the majority of horses are sound 48 hours after surgery and discharged from the hospital after 5 days. Post-surgery recovery time is short and the horse can return to the hunting field in as little as 2/3 weeks.

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