Arch Hand Microsurg.  2017 Dec;22(4):233-239. 10.12790/ahm.2017.22.4.233.

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

• Chae S
• Kim JJ

• KMID: 2406126
• DOI: http://doi.org/10.12790/ahm.2017.22.4.233

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.

Keyword

Anesthesia; Local; Epinephrine; Tendon transfer

MeSH Terms

Anesthesia
Anesthesia, Conduction
Anesthesia, Local*
Arm
Epinephrine
Follow-Up Studies
Hand
Hand Strength
Humans
Joints
Male
Metacarpophalangeal Joint
Pain, Postoperative
Range of Motion, Articular
Rupture
Shoulder
Tendon Transfer*
Tendons*
Tourniquets*
Epinephrine

Figure

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

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  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.

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  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.

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