In preparation for surgery, the hair is removed from the distal limb starting from the hoof wall and extending proximally to the mid-metatarsal/metacarpal region. The periopal and superficial hoof wall are removed with a rasp or another suitable instrument (the author routinely uses a electric sanding tool.) A waterproof barrier is established to isolate the solar region from the surgically prepared area.
2. Nerve block
To allow the horse to be anesthetized in a lighter plane without sensing any surgical pain during the procedure, a medial and lateral palmar/plantar nerve block is applied just proximal to the proximal sesamoid bone. This avoids potential complications secondary to swelling of the soft tissues between the bone and the cast, which could occur if the nerve blocks were applied at the abaxial sesamoid level, as it is typically described.
The distal leg is prepared for aseptic surgery including meticulous draping of the foot and the application of an impervious “see through” “sticky” drape over the distal limb.