Functional Outcomes of Flexor Tendon Repair in the Fingers: A Comparison of Wide-Awake Local Anesthesia No Tourniquet Versus Traditional Anesthesia

Background: Flexor tendon lacerations in the fingers are challenging injuries that can be repaired using the wide-awake local anesthesia no tourniquet (WALANT) technique or under traditional anesthesia (TA). The purpose of our study was to compare the functional outcomes and complication rates of patients undergoing flexor tendon repair under WALANT versus TA. Methods: All patients who underwent a primary flexor tendon repair in zone I and II without tendon graft for closed avulsions or open lacerations between 2015 and 2019 were identified. Electronic medical records were reviewed to record and compare patient demographics, range of motion, functional outcomes, complications, and reoperations. Results: Sixty-five zone I (N = 21) or II (N = 44) flexor tendon repairs were included in the final analysis: 23 WALANT and 42 TA. There were no statistical differences in mean age, length of follow-up, proportion of injured digits, or zone of injury between the groups. The final Quick Disabilities of the Arm, Shoulder, and Hand score in the WALANT group was 17.2 (SD: 14.4) versus 23.3 (SD: 18.5) in the TA group. There were no statistical differences between the groups with any final range of motion (ROM) parameters, grip strength, or Visual Analog Scale pain scores at the final follow-up. The WALANT group was found to have a slightly higher reoperation rate (26.1% vs 7.1%; P = .034) than the TA group. Conclusions: This study represents one of the first clinical studies reporting outcomes of flexor tendon repairs performed under WALANT. Overall, we found no difference in rupture rates, ROM, and functional outcomes following zone I and II flexor tendon repairs when performed under WALANT versus TA.

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Operative outcomes for wide awake local anesthesia versus regional and general anesthesia for flexor tendon repair

Hand Surgery and Rehabilitation ◽

10.1016/j.hansur.2021.10.312 ◽

2021 ◽

Author(s):

M. Kadhum ◽

A. Georgiou ◽

M. Kanapathy ◽

D. Reissis ◽

M. Akhavani ◽

...

Keyword(s):

General Anesthesia ◽

Local Anesthesia ◽

Flexor Tendon ◽

Tendon Repair ◽

Flexor Tendon Repair ◽

Operative Outcomes ◽

Wide Awake

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Does Digital Nerve Injury Affect Range of Motion Recovery After Zone 2 Flexor Tendon Repair?

Hand ◽

10.1177/15589447211003187 ◽

2021 ◽

pp. 155894472110031

Author(s):

Grace Keane ◽

Macyn Stonner ◽

Mitchell A. Pet

Keyword(s):

Range Of Motion ◽

Nerve Injury ◽

Flexor Tendon ◽

Tendon Repair ◽

Digital Nerve ◽

Flexor Tendon Repair ◽

Motion Recovery ◽

Flexor Digitorum ◽

The Impact

Background Evidence surrounding the impact of concomitant digital nerve injury on the outcome of zone 2 flexor tendon repair is sparse and conflicting. The purpose of this study is to assess the impact of digital nerve injury on the range of motion recovery after zone 2 flexor tendon repair. We hypothesized that digital nerve injury is independently associated with decreased motion after zone 2 flexor digitorum profundus (FDP) repair. Methods This is a single-institution, multisurgeon retrospective analysis of patients treated with primary zone 2 FDP repair. Patients with or without digital nerve injuries were included. Patients with fracture, extensor tendon injury, dysvascularity, follow-up duration of less than 10 weeks, and younger than 15 years were excluded. The primary outcome measure was Strickland percentage at the last therapy visit. Bivariate analysis was performed using simple linear regression. These results were used to guide backward stepwise multivariable analysis of qualifying exploratory variables. Results Forty-one patients with a total of 54 zone 2 FDP injuries qualified. Mean follow-up duration was 24 ± 10 weeks, and mean age was 38 ± 18 years. Thirty-three digits had a concomitant digital nerve injury, 26 digits had multidigit involvement, and 42 digits had combined FDP and flexor digitorum superficialis (FDS) injuries. Both older age and concomitant FDS injury exhibited independent relationships with poorer range of motion outcomes ( P < .05). Digital nerve injury, follow-up duration, gender, and multidigit involvement did not influence final digital motion. Conclusions In patients undergoing zone 2 FDP repair, concomitant digital nerve injury is not independently associated with poorer postoperative active range of motion.

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Autonomous Patient-Controlled Mobilization Protocol After Flexor Tendon Repair: A Case Series

Hand ◽

10.1177/1558944720964961 ◽

2020 ◽

pp. 155894472096496

Author(s):

Bárbara Gómez ◽

María Rodríguez ◽

Luis García

Keyword(s):

Range Of Motion ◽

Grip Strength ◽

Flexor Tendon ◽

Tendon Repair ◽

Case Series ◽

Flexor Tendon Repair ◽

Active Motion ◽

Early Return ◽

The Mean

Background: Despite many publications on rehabilitation after repair of flexor tendon injuries of the hand, there is no consensus as to which method is superior. It is clear that nonadherence to postoperative therapy adversely affects the outcome after flexor tendon surgery. In the context of a developing country, the most important factor associated with poor outcome is late onset of rehabilitation therapy. An autonomous rehabilitation program is proposed, with the use of a low-cost splint and based on an online illustrative video with the expectation to improve adherence and patient compliance, thus ensuring satisfactory outcome. Methods: Twenty-two consecutive digits of 14 patients after flexor tendon repair in zone II were included. Autonomous early passive mobilization physical therapy and splinting started shortly after surgery, supported by an online available video depicting prescribed exercises; follow-up was continued until postoperative week 20. Patients were evaluated regarding range of motion, grip strength, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) disability scale. Results: Range of motion after 20 weeks according to the scoring system of the American Society of Surgery of Hand was excellent in 4, good in 11, and fair in 4 fingers. The mean total active motion score was 86% (95% confidence interval, 78%-93%). The mean grip strength at final follow-up was 86% of the contralateral hand. The mean QuickDASH score was 12.5 (2.3-31.8). Conclusion: This protocol achieves good results in range of motion and early return of function of the hand. We propose this simple, nonexpensive method to developing countries with less than optimal availability of health care.

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Wide-Awake Flexor Tendon Repair Under Tumescent Injection

Iraqi National Journal of Medicine ◽

10.37319/iqnjm.1.1.5 ◽

2019 ◽

Vol 1 (1) ◽

pp. 39-51

Author(s):

Hanan Abid ◽

Sabah Naji

Keyword(s):

Range Of Motion ◽

Tendon Rupture ◽

Flexor Tendon ◽

Tendon Repair ◽

Active Movement ◽

Flexor Tendon Repair ◽

Examination Result ◽

Flexor Tendon Injuries ◽

Zone Ii ◽

No Tourniquet

Background. Flexor tendon injuries are frequent, due to variable hand activities, and the repair is challenging to hand surgeons, especially in zone II, because of the coexistence of two tendons within a tight fibro-osseous tunnel. Flexor tendon repair under tumescent infiltration provides anesthesia and a bloodless field, so that no tourniquet or sedation is needed. Aim of study. The goal of this study was to identify a surgical adjustment and intraoperative total active movement examination of the repaired tendon so that no gapping is formed, and smooth gliding is obtained, avoiding tendon rupture and producing an optimal range of motion. Patients and method. From January 2016 to April 2017, 9 patients (17 tendons), with a mean age of 31.8 years, presented within 3 to 14 days of injury to zone I or zone II of their flexor tendons. Tendon repair was done under tumescent infiltration (lidocaine 1% with adrenaline 1:200,000) only, with no tourniquet or sedation, and with an intraoperative total active movement examination. Result. After 6 months of follow up, all the patients had excellent range of motion according to the Boyes outcome scale, and none showed signs of postoperative tendon rupture. Conclusion. Tumescent infiltration for flexor tendon repair allows intraoperative surgical adjustment and total active movement examination, which will minimize postoperative rupture and adhesion. This procedure will also facilitate the surgeon’s work by eliminating the need for general anesthesia or sedation; however, this procedure is not applicable for children, major trauma, or those who are mentally challenged.

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WALANT Technique versus Sedation for Endoscopic Carpal Tunnel Release

Hand ◽

10.1177/15589447211003180 ◽

2021 ◽

pp. 155894472110031

Author(s):

Ian Wellington ◽

Antonio Cusano ◽

Joel V. Ferreira ◽

Anthony Parrino

Keyword(s):

Local Anesthesia ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Postanesthesia Care Unit ◽

Complication Rates ◽

Endoscopic Carpal Tunnel Release ◽

Average Operating ◽

Wide Awake ◽

No Tourniquet ◽

Room Time

Background This study sought to investigate complication rates/perioperative metrics after endoscopic carpal tunnel release (eCTR) via wide-awake, local anesthesia, no tourniquet (WALANT) versus sedation or local anesthesia with a tourniquet. Methods Patients aged 18 years or older who underwent an eCTR between April 28, 2018, and December 31, 2019, by 1 of 2 fellowship-trained surgeons at our single institution were retrospectively reviewed. Patients were divided into 3 groups: monitored anesthesia care with tourniquet (MT), local anesthesia with tourniquet (LT), and WALANT. Results Inclusion criteria were met by 156 cases; 53 (34%) were performed under MT, 25 (16%) under LT, and 78 (50%) under WALANT. The MT group (46.1 ± 9.7) was statistically younger compared with LT (56.3 ± 14.1, P = .007) and WALANT groups (53.5 ± 15.8, P = .008), F(2, 153) = 6.465, P = .002. Wide-awake, local anesthesia, no tourniquet had decreased procedural times (10 minutes, SD: 2) compared with MT (11 minutes, SD: 2) and LT (11 minutes, SD: 2), F(2, 153) = 5.732, P = .004). Trends favored WALANT over MT and LT for average operating room time (20 minutes, SD: 3 vs 32 minutes, SD: 6 vs 23 minutes, SD: 3, respectively, F(2, 153) = 101.1, P < .001), postanesthesia care unit time (12 minutes, SD: 7 vs 1:12 minutes, SD: 26 vs 20 minutes, SD: 22, respectively, F(2, 153) =171.1, P < .001), and door-to-door time (1:37 minutes, SD: 21 vs 2:51 minutes, SD: 40 vs 1:46 minutes, SD: 33, respectively, F(2, 153) = 109.3, P < .001). There were no differences in complication rates. Conclusions Our data suggest favorable trends for patients undergoing eCTR via WALANT versus MT versus LT.

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