Wide Awake Local Anesthesia No Tourniquet Technique for Extensor Indicis Proprius Tendon Transfer

Seungbum Chae; Jae-jung Kim

doi:10.12790/ahm.2017.22.4.233

Journal List > Arch Hand Microsurg > v.22(4) > 1106599

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Chae and Kim: Wide Awake Local Anesthesia No Tourniquet Technique for Extensor Indicis Proprius Tendon Transfer

Original Article

Hand

Archives of Hand and Microsurgery 2017; 22(4): 233-239.

Published online: 31 December 2017

DOI: https://doi.org/10.12790/ahm.2017.22.4.233

Wide Awake Local Anesthesia No Tourniquet Technique for Extensor Indicis Proprius Tendon Transfer

Seungbum Chae, Jae-jung Kim

Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu, Korea.

Corresponding author: Seungbum Chae. Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea. TEL: +82-53-650-4283, FAX: +82-53-626-4272, sbchae@cu.ac.kr

Received 21 August 2017 Revised 24 October 2017 Accepted 24 October 2017

Korean Society for Surgery of the Hand, Korean Society for Microsurgery

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the usefulness of the Wide Awake Local Anesthesia No Tourniquet (WALANT) technique for extensor indicis proprius (EIP) tendon transfer.

Methods

From January 2014 to January 2016. We selected the patients with chronic extensor pollicis longus rupture who underwent EIP transfer surgery with WALANT. We evaluated the patient's postoperative pain using visual analogue scale (VAS) scores, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and measured the range of motion (ROM) of the affected hand at the final follow-up session. And we compared total cost between WALANT operation and ordinary regional anesthesia.

Results

There were 12 patients (4 males, 8 females) with a mean age of 57.1 years. The postoperative mean VAS score was 1.25. The mean DASH score was 17.4. The mean Metacarpophalangeal joint ROM was 56.9°, interphalangeal joint ROM was flexion 81°, extension 7.1°, and mean pinch power was 91% of unaffected side. Mean grip strength was 91% of unaffected side.

Conclusion

Wide-awake approach has allowed the surgeon to know how much tendon tension on tendon repair site and tendon transfer site. The wide-awake approach makes surgeon do tendon surgery much easier and more reliable.

Keywords: Anesthesia, Local, Epinephrine, Tendon transfer

Figures and Tables

Fig. 1

Amples of premixed lidocaine and epinephrine (1:100,000).

Fig. 2

(A) We pinched the skin slightly and stuck 25 G needles vertically to inject the premixed local anesthetics. (B) The hand after injection of local anesthetics.

Fig. 3

(A) Exposure of the ruptured extensor pollicis longus (EPL) tendon by making incision to the ruptured spot. (B) After rearranging the extensor indicis proprius tendon to the ruptured EPL, temporary sutures are made. (C) After temporary sutures are made, tensions of the tendons are checked by repetitive extension and flexion of the two thumbs.

Table 1

Patient demographic

Values are presented as number only, mean only, or median (range).

Table 2

Functional results

Values are presented as median (range).

IP: interphalangeal, MP: metacarpophalangeal, ROM: range of motion, DASH: Disabilities of the Arm, Shoulder, and Hand.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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