Wound repair can be performed with the horse standing or under general anesthesia. Many lower limb lacerations can be thoroughly examined, lavaged, debrided, and reapposed with the horse standing and sedated. In general, if severe injury is suspected or additional therapies are proposed, such as arthroscopy, then it is best to have the horse under general anesthesia. Otherwise, perineural or local anesthesia can be utilized effectively. Local anesthesia is effective for mobilizing and suturing large flaps of skin, but is not very good at desensitizing enough area so that sufficient wound debridement can occur. Perineural anesthesia is generally better because it will facilitate the standing horse being able to tolerate debridement, multiple arthrocentesis, and distension of one or more synovial structures. Two of the most common sites for perineural anesthesia in horses with distal limb lacerations are the abaxial sesamoid and low 4-point nerve blocks.
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