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

Abstract

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.

Wide-Awake Local Anesthesia No Tourniquet (WALANT) for Flexor Tendon Repairs as Change in Practice During the COVID-19 Pandemic: A Retrospective Cohort Study With Outcomes

“…WALANT is also known to save time and money, reduce anesthetic complications, and improve patient turnover time [ 9 - 12 ]. There is a lack of literature on the outcomes of flexor tendon repairs performed under WA anesthesia, and this study is one of the few to date addressing this issue [ 4 , 5 , 13 ].…”

“…Our goal was to review the 12-week ROM outcomes using the original Strickland score for both groups; we found a positive trend toward better outcomes in the WA group. This is one of the first studies comparing zones I and II flexor tendon ROM outcomes between WA and TA [ 5 ]. Excellent to good outcomes in the WA group were reported in 56% of the cases versus 31% in the TA group, although the difference was not statistically significant (Table 2 ).…”

“…Thirty-three patients did not attend their follow-up appointments and 11 patients were referred to peripheral therapy units out of 44 who did not have 12-week ROM outcomes. Townsend et al reported total active motion outcomes for different digits as overall “fair” in both the WALANT and TA groups, apparently using criteria from the American Society for Surgery of the Hand, although this was not explicitly mentioned [ 5 , 14 ]. None of the patients showed dissatisfaction with the WA anesthesia and the majority of them scored their pain between 3 and 5 on a scale of 0-10 while the local anesthesia solution was injected, although this was not formally recorded.…”

“…WALANT surgery has gained popularity recently for flexor tendon repairs due to the advantage of assessing the tendon glide and the quality of repair intraoperatively [ 1 ]. Outcome data of flexor tendon repairs performed under WALANT is still limited to only some recent literature [ 4 , 5 ]. The primary aim of this study is to compare the 12-week range of motion (ROM) flexor tendon repair outcomes between the patients in the traditional anesthesia (TA) group and the patients who were operated under wide-awake (WA) anesthesia without sedation.…”

Flexor tendon laceration of the hand from opening a glass ampoule

“… 9–11 The outcomes of flexor tendon repair using WALANT and traditional anaesthesia showed similar functional outcomes and complications in two recent studies. 19 20 However, WALANT clearly offers the advantage of local anaesthetic combined with the ability to test the repair intraoperatively.…”