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Equine Laser Procedures

EQUINE DIOWAVE LASER THERAPY & SURGERY

For many years, the use of laser energy sources has been a highly advocated technique in equine upper respiratory surgery, yet has remained beyond the use of the vast majority of general practitioners. Previous limitations have included cost, the requirement for special training, and the large size of equipment, restricting their value to most veterinarians. With the development of the Diowave™ Veterinary Diode Laser, these surgical techniques are now within the reach of all veterinarians.

Laser surgical techniques are more commonly replacing traditional surgical methods. Advantages include avoidance of the risks associated with general anesthesia, reduced surgical morbidity and rapid post-operative recovery. In addition, laser surgery presents a method of accurate surgical dissection with inherent hemostasis minimizing the risk of intra-operative bleeding.

INTRODUCTION TO LASER SURGERY

The effect of diode lasers on tissue is dependent on a number of factors. The wavelength of the laser energy is important with diode laser sources operating at wavelengths of around 980 nm and allowing tissue penetration in a diffuse beam of up to 3-4 inches, which has implications for therapeutic applications. The exposure time of the tissue to the energy source and the power of the laser energy, also affect the ablation and vaporization of tissues, as well as the local blood supply of the region. Finally, the method of application has important implications with a contact technique between the fiber-optic cable and the tissue being advocated to ensure accurate control of the laser output.

The use of lasers requires a means of delivery of the energy using fiber-optic cables. Laser scalpel devices such as the Diowave™ laser are available, which are particularly applicable to cutaneous surgical techniques, particularly tumor removal and endoscopic applications. Lasers are used in upper respiratory surgery with fiber optics placed through the biopsy channel of endoscopes in order to reach the surgical field. Today, the Diowave™ laser is an established instrument in many upper airway procedures. It offers more accurate dissection of tissues with its inherent hemostatic properties limiting tissue bleeding and post-operative complications. In addition, in many circumstances anesthesia can be avoided resulting in lower morbidity procedures associated with a quicker return to full activity.

CUTANEOUS TUMOR REMOVAL

This is a very common laser technique used in many hospitals. Advantages over conventional techniques include improved hemostasis compared to sharp dissection but also latent thermal necrosis of the resected margins. Laser energy interacts with tissues in one of four methods: transmission, absorption, scattering and reflection of the laser energy, resulting in vaporization, with a surrounding area of carbonized tissue. Beyond this region, thermal necrosis will generate a margin of tissue destruction beyond the plane of resection; this may be desirable during the removal of invasive tumors.

VOCAL CORDECTOMY AND VENTRICULECTOMY

Following cutaneous tumor removal, this is probably the most common application of laser surgery in most animal hospitals. This technique is preferred to the standard surgical technique for ventriculectomy (sacculectomy) via a laryngotomy incision as it is noninvasive and requires no general anesthesia. During the procedure, hemorrhage is the most commonly encountered complication and it is important to take care not to extend the incision to the abaxial surface of the vocal fold where there are many blood vessels. This procedure may be combined with prosthetic laryngoplasty. As a sole procedure, laser ventriculocordectomy has been shown to be effective at reducing airway noise and improving performance in horses with recurrent laryngeal hemiplegia. It should be noted that laryngeal swelling may occur post-operatively, and it is important to have close monitoring and tracheotomy equipment available if necessary.

DORSAL DISPLACEMENT OF THE SOFT PALATE

Laser cautery of the caudal aspect of the soft palate has been advocated as a potential treatment of dorsal displacement of the soft palate (DDSP), and may be combined with sternothyroid tenectomy. Currently, there is insufficient evidence-based medicine to determine whether this is any more effective than conservative treatment. Prior to cautery, the pharynx is irrigated with local anesthetic solution. The technique involves the 1-2 seconds of contact application of the laser fiber to the free border of the soft palate. These should extend rostrally for 3-4cm, each spread by 2-4mm. Minimal hemorrhage commonly occurs adjacent to the epiglottis.

PROGRESSIVE ETHMOID HEMATOMA

Laser treatment has been advocated for treatment of progressive ethmoid hematoma, which may in part be due to the lack of a definitive treatment protocol. The use of lasers is restricted as with other methods by access, but may be useful for lesions in the middle nasal conchae.

RESPIRATORY MASSES

Reasonable success can be achieved with laser surgery in the treatment of respiratory masses, even those deep within the bronchi. Care must be taken to minimize the risks of thermal necrosis of adjacent structures, and it is important to remember that even the locally heated air may reach sufficient temperatures to result in mucosal discomfort. Some highly specialized endoscopy systems have a second channel to allow for removal of the smoke plume and heated gases by suction. Alternatively, the application of laser energy should be intermittent to minimize this heating effect.

COMPLICATIONS

It should be noted that upper respiratory surgeries performed under standing sedation are considered significantly safer than those performed under general anesthesia. This is in part due to the inherent risks of general anesthesia, but also due to the risk of working near pure oxygen with its inherent fire risks.

The surgical laser can be used to create this opening or it can be used to create an opening from the pharynx into the affected pouch. Either approach can be performed through the video endoscope on an outpatient basis with the foal standing under sedation.

Guttural pouch empyema is a condition that occurs when the guttural pouch is filled with fluid or somewhat solidified purulent material.  It is extremely difficult to resolve the infection with flushing and antibiotic treatments alone.  The laser can be used to create a surgical opening from the throat area directly into the guttural pouch (salpingopharyngeal fistula) allowing the infectious material to drain passively.

DORSAL DISPLACEMENT OF THE SOFT PALATE

Dorsal displacement of the soft palate consists of the displacement of the soft palate on top of the epiglottis.  This causes exercise intolerance and abnormal respiratory noise in performance horses.  Several techniques have been described with varying success for the treatment of dorsal displacement of the soft palate.  One therapy in conjunction with traditional surgical techniques is application of a laser in several small areas at the free edge of the soft palate.  The theory behind this treatment is to produce scar tissue and stiffen the edge of the soft palate to prevent further displacement. The laser can also be used to resect the free edge of the soft palate (Staphylectomy) under video endoscopic guidance. Previously, this type of surgery was only done with the horse under anesthesia and through a skin incision into the throat.

UPPER RESPIRATORY TRACT CYSTS & MASSES

Masses within the upper airway (trachea, pharynx, larynx) as well as cysts in the epiglottis, pharynx, and nasal passages can all be treated with laser surgery. Laser surgery can be used to remove the masses/cysts with minimal trauma to the surrounding tissue, decreased bleeding, and decreased recurrence when compared to traditional surgical approaches.

SKIN TUMORS

Most surgical skin diseases in large animals are neoplastic (cancer) in origin.  Removal or destruction of the diseased tissue is the goal of any therapy.  Laser surgery for these lesions both alone and in conjunction with chemotherapy can decrease recurrence rate and speed recovery.  Laser excision of tissue causes less swelling to surrounding tissue and less spread of neoplastic cells to

surrounding areas when compared to excision with sharp instrumentation.  Typical skin tumors removed with laser surgery include sarcoids, squamous cell carcinomas, and melanomas.

SKIN GRAFTS

Lasers can be used to prepare the healing wound bed (granulation tissue) for skin grafting.  They can be used to remove the exuberant healing tissue that is often seen in horses and to sterilize the wound bed.  The use of the laser also allows for less bleeding in the highly vascularized tissue and less swelling when compared to other methods.  The laser creates an ideal environment for the new tissue to grow.

NEURECTOMY

Neurectomy (removing a section of nerve) is a treatment in large animals to reduce pain from progressive, debilitating disease processes.  Removal of a small piece of the nerve supplying sensation to the painful area eliminates the sensation of pain the animal feels.  Although this does not treat the disease, it does relieve pain to the animal allowing a more comfortable life.  The most common complication of a neurectomy is regrowth of the nerve or formation of a painful neuroma (swelling at the nerve end).  Using a laser to remove the nerve seals the end of the nerve tissue decreasing the occurrence of neuroma formation.

OTHER

Various other surgical procedures utilize lasers.  Lasers can be helpful in breaking up bladder stones; they are also being used to remove cartilage in the lower hock joints and to aid in fusing a joint (arthrodesis) for treatment for chronic arthritis.  Lasers are also being used during laparoscopic procedures to seal vessels and prevent hemorrhage.  As surgical techniques continue to advance, the laser will be used to treat an increasing number of diseases.

CONCLUSION

Laser surgery is a specialized type of surgical technique made possible with the versatile Diowave™ Laser.  The main advantage of performing these types of surgical procedures in large animals is that it allows the surgeon to reach obscure areas and perform surgery through a minimally invasive approach without general anesthesia.  If you have any questions regarding laser surgery, you should contact your ACVS board-certified veterinary surgeon.

INTRODUCTION TO EQUINE LASER THERAPY

All equine therapists are aware that injury prevention and prompt treatment are crucial to peak equine performance (an injured horse cannot train at peak levels, therefore, cannot reach peak genetic performance potential); with a Therapy Laser you will have a modality at your fingertips that will perform these functions and even more.

A Therapy Laser provides a higher degree of treatment outcome in less time and effort than all other Laser and LED devices on the market.  Some of the direct benefits include:

• Reduces recovery time from injury and illness

• Does not mask symptoms but corrects muscle-related problems by directly treating them

• Enhances performance without medication and inherent side-effects

• Alleviates pain and soreness from strenuous training

• Reduces stress levels in the horse, both physical and psychological

• Improves concentration and enhances learning ability

• Improves respiratory, digestive, immune, and neural systems

• Increases venal and lymphatic circulation

• Prevents additional injury (saving money, as well as pain and trauma to the animal)

• Ultimately improves the animal’s quality of life

COMPARISON TO PHARMACEUTICAL RELAXANTS

This form of chemotherapy works via the entire nervous system and is indicated in cases of entire body muscle seizure as in a traumatic accident or shock; however, depressing the horse's entire nervous system is contraindicated in addressing specific muscle problems.  Drug therapy can relax a general muscle mass (like heat), but since it affects the contraction as well as the release processes of the muscles, it diminishes the horse's overall strength and capability.  Though necessary in cases following acute trauma, as a treatment modality in chronic situations, it is often ineffective.

COMPARISON TO ELECTRICAL STIMULATION

Electrical Stimulation devices work by adding contraction to a muscle that already cannot find release.  This may not be the best way to release muscle spasms.  These devices can be useful for low levels of pain relief, for neuromuscular diagnosis, and for exercising a muscle with deficient nerve impulse (nerve damage).

EQUINE LASER THERAPY

Laser Therapy offers effective multiple treatment applications and results; from the relief of pain, to the improvement of inflammation and swelling within muscles, joints and tendons as well as the ability to accelerate the healing of wounds.  Conditions treated successfully include:


Soft Tissue Injuries

• Tendonitis

• Tendosynovitis

• Bowed Tendons

• Suspensory Disorders

• Inferior Check Ligament Desmitis

• Bucked Shins

• Carpal Tunnel Syndrome

• Hydroma of the elbow

• Superior Check Ligament Strain

• Thoroughpin

• Tarsal Plantar Desmitis (Curb)

• Stringhalt

• Capped Hocks

• Myositis

• Exertional Rhabdomyolysis

• Wound Healing

• Greased Heels

Joint Related Injuries

• Arthritis

• Epiphysitis

• Carpitis

• Fractures

• Splints

• Sesamoiditis

• Bone Spavin

• Trochanteric Busitis

• Osselets

• Ringbone

• Tarsitis

• Stifle Disorders

Neck, Back and Vertebral Column

• Hunter’s Bumps

• Subluxations of the Sacroiliac Joint

• Cervical Musculature

• Thoracolumbar Musculature

Hoof

• Laminitis

• Navicular Syndrome

EQUINE LASER THERAPY VS. OTHER ADJUNCT TREATMENT MODALITIES

All equine therapists are aware that injury prevention and prompt treatment are crucial to peak equine performance (an injured horse cannot train at peak levels, therefore, cannot reach peak genetic performance potential); with a Therapy Laser you will have a modality at your fingertips that will perform these functions and even more.

Therapy Laser provides a higher degree of treatment outcome in less time and effort than all other Laser and LED devices on the market.  Some of the direct benefits include:

• Reduces recovery time from injury and illness

• Does not mask symptoms but corrects muscle-related problems by directly treating them

• Enhances performance without medication and inherent side-effects

• Alleviates pain and soreness from strenuous training

• Reduces stress levels in the horse, both physical and psychological

• Improves concentration and enhances learning ability

• Improves respiratory, digestive, immune, and neural systems

• Increases venal and lymphatic circulation

• Prevents additional injury (saving money, as well as pain and trauma to the animal)

• Ultimately improves the animal’s quality of life

COMPARISON TO PHARMACEUTICAL RELAXANTS

This form of chemotherapy works via the entire nervous system and is indicated in cases of entire body muscle seizure as in a traumatic accident or shock; however, depressing the horse's entire nervous system is contraindicated in addressing specific muscle problems.  Drug therapy can relax a general muscle mass (like heat), but since it affects the contraction as well as the release processes of the muscles, it diminishes the horse's overall strength and capability.  Though necessary in cases following acute trauma, as a treatment modality in chronic situations, it is often ineffective.

COMPARISON TO ELECTRICAL STIMULATION

Electrical Stimulation devices work by adding contraction to a muscle that already cannot find release.  This may not be the best way to release muscle spasms.  These devices can be useful for low levels of pain relief, for neuromuscular diagnosis, and for exercising a muscle with deficient nerve impulse (nerve damage).

CONTRAINDICATIONS

­ • Hemorrhaging: Do not apply laser light to any lesion that is actively hemorrhaging

• Direct Irradiation of the Eyes: Laser energy is harmful to the eye never shine laser light into the eyes at any time, even while wearing safety goggles

• Testicles: Do not apply laser light to the testicles of the stallion

• Corticosteroids: Do not apply laser light to any area that has recently been injected with corticosteroids

• Photosensitive Medications: Do not apply laser light to any animal that is currently receiving photosensitive medications

• Epiphysitis: When applying laser light to epiphysitis, use a low dose initially and use only those treatments necessary to reduce swelling

• Carcinomas Melanomas, Sarcoids, or any other irregular or abnormal cellular growth: Do not use laser over any known primary or secondary lesions.

• Pregnancy: Laser therapy is contraindicated for use over the pregnant uterus; do not apply laser ltherapy to a pregnant mare.

• Sympathetic Ganglia, the Vagus Nerves & Cardiac Region in Horses with Heart Disease

Laser therapy may significantly alter neural function, and is therefore contraindicated over these regions in horses with heart disease.

EQUINE LASER THERAPY PERFORMANCE ENHANCEMENT 

Injury Prevention

Acute injuries are often the result of long term, cumulative damage resulting from rigorous schooling programs and show schedules. Minimizing the inflammatory reaction and subsequent tissue damage through consistent post-workout management practices can be the key to preventing a serious injury. Regular preventive laser therapy treatments can be instrumental in preventing conditions from becoming acute.

Big Knees / Epiphysitis

This is an inflammation of the growth plate of the long bones, primarily found in the lower end of the radius above the knee. An enlargement or swelling over the knee that is firm or painful should be checked by a veterinarian. This condition responds very well to laser therapy treatments.

Bowed Tendon

Any damage to the tendon, which causes inflammation, may be referred to as a bow. The terms tendonitis and Tendosynovitis differentiate between an inflammation involving only the tendon and one which involves both the tendon and its sheath. Damage to the tendon may result in a high, middle, or low bow in addition to the classic bow, which involves all three categories. Immediate attention can mean the difference between enabling the horse to return to work or retirement. If there is any indication that the horse may have a bowed tendon, laser therapy can reduce inflammation and minimize the detrimental effects of the condition.

Capped Hock

A capped hock is the inflammation of the bursa over the point of the hock. A cap forms, which may be soft, and fluid fills around the area when it is fresh. Initially the swelling of the bursa will be soft and varied in size, but eventually will harden. Lameness rarely occurs and almost never persists, and if it is present, will be mild. Laser therapy can be instrumental in healing this condition.

Check Ligament

The check ligament can be strained by a simultaneous dorsal flexion of the fetlock and over flexion of the knee. The result will be an acute or chronic lameness depending on the severity of the tendon tear. Laser therapy is very useful in healing the strain that can cause lameness.

Cunean Tendon

Bursitis of the Cunean tendon in the hock is thought to be caused by strain. The bursa involved in bursitis of the Cunean tendon is between the tendon itself and the ligaments overlaying the tarsal bones. Laser therapy is indicated to reduce strain and inflammation.

Despites

The suspensory ligament can be strained, sprained, or ruptured. A strain is stress on the ligament, which results in soreness and inflammation. A sprain also involves stress and inflammation, but goes on to incur actual tearing of some fibers of the ligament. A rupture is a complete tearing of a section of the fibers of the ligament. The involved inflammation of the ligament related to all three types of injuries is called Desmitis. Laser therapy is indicated to reduce the inflammation and heal the soreness and strain, and to increase blood flow to the injured area.

Suspensory Ligament / Strains and Sprains

Strains and sprains of the suspensory ligament can result in acute lameness and swelling in the early stages. In the chronic stage, there is extensive fibrosis (scar tissue) and swelling near or at the attachment to the sesamoid bone. X-Ray and/or Ultrasound by a veterinarian will determine the extent of the damage to the horse. Laser therapy can reduce the scar tissue and swelling in the injured areas.

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