Immediate Thumb Extension following Extensor Indicis Proprius???to???Extensor Pollicis Longus Tendon Transfer Using the Wide-Awake Approach

Abstract

The wide-awake approach has allowed the authors to adjust tendon transfer tension with active movement before skin closure without the risks associated with general or regional anesthesia. In addition, it has allowed them to observe immediate cortical adaptation in the context of a simple tendon transfer. The authors hypothesize that the brain's ability to immediately use extensor indicis proprius for thumb extension stems from the activation of preexisting synergistic cortical finger movement programs.

Immediate Postoperative Active Mobilization Versus Immobilization Following Tendon Transfer for Claw Deformity Correction in the Hand

“…Hager-Ross and Schieber 10 described the individuation index to quantify the degree to which noninstructed digits move during instructed movement of a given digit. Early postoperative mobilization activates the new neuronal networks in the brain as described by Bezuhly,11 whereas immobilization may temporarily erase these neuronal networks. In addition, immobilization of the transfer will temporarily erase the cortical representation of FDS middle finger as demonstrated by de Jong et al 12 with dynamic immobilization of flexor tendons.…”

Update/Review

“…5–7 The dosage and location of local anesthetic infiltration for tourniquet-free common hand surgery operations has been published 8 (Table 1). “Wide-awake local anesthesia no tourniquet” (WALANT) technique has been published widely for carpal tunnel surgery, 9 flexor tendon repair, 10 tendon transfer, 11 Dupuytren’s contracture, 12 and trapeziectomy. 13 …”

“…11 Patients are able to demonstrate during the surgery that the transfer is too tight or too loose, and the surgeon can adjust the tension before the skin is closed (Fig. 1).…”

Discussion: Do Not Use Epinephrine in Digital Blocks: Myth or Truth? Part II. A Retrospective Review of 1111 Cases

“…The benefits of watching comfortable patients actively move their repaired flexor tendons 9 before closing the skin have been a major step forward in decreasing flexor tendon rupture 10 and getting the tension right in tendon transfers. 11 The cost saving of wideawake carpal tunnel repair is enormous 12 and has reduced the inconvenience to the carpal tunnel and most other hand surgery patients to the level of a visit to the dentist. 13 The clinical significance of this 2010 article is that the validation of the safety of epinephrine in fingers is yet again demonstrated.…”