Wide awake surgery for flexor tendon primary repair: A literature review

Abstract

Flexor tendon injuries are extremely challenging conditions to manage for hand surgeons. Over the last few years enormous progress has been made for the treatment of these lesions with new surgical approaches being performed. One of these is the wideawake local anesthesia no tourniquet (WALANT) technique, also known as Wide Awake Technique that allows tendon repair under local anesthesia, enabling the tendon to move actively during surgery. Dynamic movement of the tendon during surgery is crucial for the orthopedic surgeon in order to understand if the tendon has been correctly repaired before leaving the operatory table. An electronic literature research was carried out on Pubmed, Google Scholars and Cochrane Library using ((Flexor tendon injury) OR (flexor tendon) OR (injury muscle tendon) OR (flexor pollicis longus tendon) AND ((wide awake repair) OR (wide awake) OR (wide awake hand surgery))as search terms. Authors believe that WALANT is an enormous add-on in the management of patients with flexor tendon injuries mainly because it allows direct visualization of the repair during flexion and extension movement of the fingers and also because it avoids general anesthesia or brachial plexus being more cost effective. The aim of these review was therefore to sum up the evidences available so far on the wade awake technique as an emerging treatment for patients with flexor tendon injuries.

Safety of wide-awake local anesthesia with no tourniquet (WALANT) in for lower limb surgery: A potential alternative in times of emergency

“…An open reduction and internal fixation surgery of ankle fractures using WALANT technique reported a mean operation time of 59.72 ± 7.19 min (8), which is approximately the same as the duration recorded in this current study (65.28 ± 39.02 min). Another similar study involving ankle operation reported a shorter mean surgery duration of 36.6 ± 7 min (7).…”

“…The mean EBL recorded in the current study was 91.34 ± 78.94 cc, which is higher compared to the average amount of blood loss recorded (29.40 ± 7.38 ml) in an ankle fracture fixation surgery using the same WALANT technique (8). This is probably due to the majority of patients (50.6%) in this study underwent soft tissue surgery, which may lead to more blood loss compared to procedures involving ankle fracture fixation.…”

Flexor tendon laceration of the hand from opening a glass ampoule

“…This can minimise adhesions postoperatively and maximise patient outcomes. [9][10][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.…”

“…Flexor tendon lacerations are uncommon injuries but remain to be one of the most challenging injuries to treat, especially zone II injuries (figure 1). 8 9 In established flexor tendon lacerations, surgical repair is usually warranted with the traditional manner of using a tourniquet and the patient either sedated under regional or general anaesthesia. In such cases, active movement of the repaired tendon is not possible.…”

One Year of COVID-19: Lessons Learned in a Hand Trauma Center

“…The authors did not use telemedicine, and Toia et al [11] as well as Leti Acciaro et al [27] confirmed it might be an issue in Italy. To reduce contamination risks [28], some surgeons increased non-surgical treatment [9,23], and to resolve issues linked to a diminution of anesthetists' availability, many hand surgeons [9,12,14,17,24,29] stated to use WALANT surgery [30].…”