Keratoma

[David Gill]

Dear All
An associate of mine (not a farrier) has been in touch regards some advice.
His words are below:

“Could you give me some advice please?
One of our horses has been intermittently lame for some time and our farrier...thought that it may be caused by a tumour.
We called in the vet and the horse is in the middle of an operation to remove the Keratoma.
They operated yesterday but failed to remove it all and will continue on Tuesday after the Bank Holiday!!
It seems that the tumour is more extensive than expected and is affecting the pedal bone.
Have you had any experience with this condition and how long would you estimate it would be on box rest?”

So, can any of you guys help him?
Best regards, David

[Jason Maki]

I am not a vet, but have been involved in a few of these. A couple were removed under anethesia with minimal invasion and loss of horny structure. in these cases i was asked to apply a straight bar with a fattish bar on the frog and a hospital plate. I would assume a normal work load could start when the surigical incision has healed and the clinician felt the capsule was sturdy.
I've also assisted in the removal of a dorsal wall that was basicly free floating secondary to a keratoma. I just reset him last week, and the section was removed in October of 08. the new dorsal growth is about 2/3 of the way down and he is sound. However he is not being ridden. We used a heartbar for three resets and a bar screwed across the gap to stabalize it until the gap was half filled. He is now in a straightbar with a big rocker.
The attending surgeon would have much better insight into the details of the case, but this general info might help a bit.
jason

[J.H. shoeing]

I had one last year. They went thru the sole in the lateral toe the hole was about as big as a quarter(large coin). I applied a straight bar shoe with a hospital plate. Reset it several times, I cant remember how long the stall rest was. After the stall rest they were hand walking him for a while and he is back into full work now. Pro-level barrel horse.

I used some frog support along the way too but will have to read the case notes to freshen my memory.

[Ronald Aalders]

Removing a keratoma should not cause too much trouble. Especially when the keratoma is located in the toe area as they often are, removal is easy. Locate the keratoma and establish how big it is. X rays are needed for this purpose. Although I removed a couple without rads. With or without involvement of P3 the removal of a keratoma is the same. Have the foot sedated with a nerve block. If you're a sensitive type (or when the owner is) throw in a tourniquet. If the keratoma is big, apply a suitable frog and sole support shoe with a lot of break over. (A banana works best) You will remove connection between the wall and P3 when removing the keratoma and you do not need any trouble due to loosing that bond. I know some feel that's not needed since the keratoma did not offer any bond anyway, but better safe than sorry. Thin the dorsal hoofwall with you rasp or halfrounds (the 3/8" halfrounds MFC makes are great for this!) and cut vertical grooves left and right of the keratoma (the width in most cases can be guestimated when looking at the wall/sole junction and the distorsion of that junction. Cut all the way through the wall into the lamillae and all the way up to the papillae. Don't go into the papillea, you don't want to distort that. When done grooving use a specially designed tool for this purpose (some call them pull offs) and break away the wall with the keratoma from the sensitive lamillae. When more or less loose, pull the defect completely loose in a downward direction so not to ruin the papillae. Check for unwanted damage (there shouldn't be any). Dress the foot or better still have the vet do that.

Recovery of this kind of keratoma is surprisingly fast. This one was lame for a week or so.

Usually a pretty easy procedure that you'll be way better at than any vet. So don't shy away from helping that vet in such cases.



Ronald Aalders

[SlowShoe]

Ron,

Well all I can say is wow.

[Rick Burten]

Great stuff Ron. Thanks for that.

[David Gill]

I’d like to thank Jason, Jeff and particularly Ronald for their input on this thread.

The owner of the horse is a saddler by trade and it would be nice to think that after viewing this forum as a visitor, he may at sometime be inclined to share his experiences of the horse, from his view point and relate those experiences to the many lameness issues, which we as farriers deal with on a daily basis.

Once again many thanks and most importantly, thank you for this forum.

[reillyshoe]

A couple of thoughts about how we deal with Keratomas at New Bolton. In most cases, the keraoma is removed under general anesthesia. Collogen sponges are placed in the defect and a surgical grade PMMA plug applied to the level of the dorsal hoof. A patch of fabric saturated with hoof repair material is placed over the hoof, and then a shoe applied (glued on). This is all done under anesthesia.
In some cases with infection present, we look for access to medicate the region while maintaining the hoof capsule integrity and keeping the debrided area clean (description following).

[reillyshoe]

A keratoma following debridment:
http://www.horseshoes.com/forums/picture.php?albumid=176&pictureid=1346

The drain consists of a 1/4 inch steel tee nut (shown from different angles with 1/4 x 1/2 inch slot head screw):

http://www.horseshoes.com/forums/picture.php?albumid=176&pictureid=1347

[reillyshoe]

A hole is pierced in fabric saturated with repair adhesive (braided polyester shown here), and the tee nut inserted. The fabric strip is positioned over the defect:

http://www.horseshoes.com/forums/picture.php?albumid=176&pictureid=1348

The screw and plate are still partially exposed. To make up this difference, and second strip of material is saturated with repair adhesive, a hole pierced in the center, and positioned over the first repair (the screw is removed prior to each application, coated with a release agent, and then reapplied before the adhesive polymerizes). The result of the second repair is a perfectly flush screw which can be removed, the defect flushed with a syringe, and reapplied to keep the area clean.

http://www.horseshoes.com/forums/picture.php?albumid=176&pictureid=1349

[reillyshoe]

A shoe is applied, with the rim pad removed to float the area under the surgical site.

http://www.horseshoes.com/forums/picture.php?albumid=176&pictureid=1350

[brian robertson]

Very slick there, Pat.

[Gabino]

Ron,Patrick, excellent work!! I debrided some keratomas with good results. I think the big problem is keeping the hoof stabilization. We use the Vetcast band for stabilize the hoof capsule.

http://img381.imageshack.us/img381/2120/p1010593.jpg (http://img381.imageshack.us/my.php?image=p1010593.jpg)

http://img381.imageshack.us/img381/5719/p1010600j.jpg (http://img381.imageshack.us/my.php?image=p1010600j.jpg)

[ladyblacksmith]

Question: It looks like this should be care for by a vet/farrier under controlled conditions, and not at someone's barn?

I have yet to run into this situation.

[Gabino]

I think is neccesary the colaboration vet/farrier, but not indispensable operating theatre. In my case, we pull off the sferic keratoma at the clinic,but in the box door.

[reillyshoe]

We like to keep the surgery under the most ideal conditions possible and this is why we debride and shoe most of these in the operating room.
It is impossible to make a hoof sterile, but I prefer the most aseptic conditions possible.

[ladyblacksmith]

We like to keep the surgery under the most ideal conditions possible and this is why we debride and shoe most of these in the operating room.
It is impossible to make a hoof sterile, but I prefer the most aseptic conditions possible.


Thank you.

[Red Amor]

Its amasing isnt it
We see hoofes cut in half be wire , tin class what ever some times these havent been noticed for some time days ?the bones exposed covered in mud poo whatever and the have no trouble
yet someone goes to the trouble to be very clean n tidy and the reched animal end up dieing septic
If Im alowed to I like to put the extra efort in to help
sometimes were not and we still get lucky?:confused:

[jim-suny]

The majority are caused by letting clips back to far or anther foreign body creating pressure, address the removal of pressure or foreign body causing it and in most cases they will resolve them self over time with out drastic measures.:)