Usefulness of Wide-Awake Local Anesthesia No Tourniquet Surgery to Decide on Tendon Transfer Versus Grafting in Chronic Flexor Tendon Rupture

Zukawa, Mineyuki; Osada, Ryusuke; Hirokawa, Tatsurou; Suzuki, Kayo; Makino, Hiroto; Kawaguchi, Yoshiharu

doi:10.1016/j.jhsg.2022.04.001

Cited by 3 publications

(2 citation statements)

References 26 publications

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“…The upper limb remains under motor control by the wide awake patient. He can help by moving reconstructed parts actively during the surgery, when certain procedures need balanced fixation or tension of joints and tendons, such as in flexor tendon repair, boutonniere fingers, or in tendon transfers (25,26,27,28). Pain control persists after surgery, diminishing the need for opioids when compared to general or regional anesthesia (29,30,31,32).…”

Section: Local Anesthesia: the Numbness Is Administeredmentioning

confidence: 99%

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WALANT surgery of the hand: state of the art

Degreef,

Lalonde

2024

EFORT Open Reviews

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Wide-awake local anesthesia no tourniquet is named the WALANT technique. WALANT has had a major positive impact on cost, convenience, ecology, patient satisfaction, access to surgical care, and outcomes in hand surgery in the last 20 years. Safe and efficient application of the technique is based on two principles. The first principle is the tumescent injection of a large volume low concentration 0.25–1% lidocaine, with 1:100 000–1:400 000 epinephrine. The second principle of WALANT is that the proper injection should be almost painless, with the patient only feeling the first needle poke of a tiny 30G needle. This wide awake patient approach reduces pain, neuropraxia, and systemic side effects of sedation with preservation of motor control, thereby aiding balanced reconstruction in hand surgery.

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Section: Local Anesthesia: the Numbness Is Administeredmentioning

confidence: 99%

“…It permits intraoperative testing of active motion to identify small remaining adhesions that can affect the result. Active motion during the procedure often helps to release the tendons and regain mobility (25).…”

Section: Tendon Surgerymentioning

confidence: 99%

WALANT surgery of the hand: state of the art

Degreef,

Lalonde

2024

EFORT Open Reviews

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Wide-Awake Local Anesthesia No Tourniquet Surgery for Zone VII Extensor Tendon Reconstruction: Stages in Active Range of Motion From Intraoperative to Final Recovery

Osada,

Zukawa,

Hirokawa

et al. 2023

The Journal of Hand Surgery

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Wide-Awake Tenolysis for Tendon Entrapment in a Distal Radial Epiphyseal Separation (Volar Displacement Type): A Case Report

Mori,

Yamamoto,

Kubota

et al. 2024

Cureus

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The patient was a 13-year-old male who fell while riding a bicycle and was initially diagnosed with a distal radial epiphyseal separation (volar displacement type) that was conservatively managed. Four months post-injury, he complained of limited movement in his left index finger and was referred to our hospital. Upon examination, the patient also complained of limited movement of the left index finger in wrist flexion. The wrist range of motion was 50° of volar flexion, 50° of dorsiflexion, 90° of pronation, and 90° of supination with the fingers extended. The X-ray revealed a radiolucent area in the distal radius. Ultrasound, computed tomography, and magnetic resonance imaging scans demonstrated entrapment of the extensor tendon within the medullary cavity of the radius. Five months post-injury, surgery was performed using the wide-awake local anesthesia no-tourniquet (WALANT) technique. A dorsal wrist approach was utilized, and the extensor digitorum communis tendon was found to be trapped within the medullary cavity of the radius. The tendon was released using an air drill, and sufficient improvement in the left index finger flexion was confirmed with active movement before concluding the surgery. At the 11-month postoperative follow-up, the patient showed excellent outcomes with a wrist range of motion of 75° of volar flexion, 85° of dorsiflexion, 90° of pronation, and 90° of supination. Tendon entrapment of the extensor tendons has been reported as a long-standing complication associated with distal radius fractures, particularly with volar displacement types. A benefit of the WALANT technique is the ability to communicate with the patient during surgery, allowing for active movements of the fingers and wrist. This is particularly useful in tendon surgeries for determining tendon tension. We report a case of successful tenolysis surgery using the WALANT technique for a patient with a conservatively managed distal radial epiphyseal separation (volar displacement type), who experienced a limited flexion of the index finger due to tendon entrapment.

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Usefulness of Wide-Awake Local Anesthesia No Tourniquet Surgery to Decide on Tendon Transfer Versus Grafting in Chronic Flexor Tendon Rupture

Cited by 3 publications

References 26 publications

WALANT surgery of the hand: state of the art

WALANT surgery of the hand: state of the art

Wide-Awake Local Anesthesia No Tourniquet Surgery for Zone VII Extensor Tendon Reconstruction: Stages in Active Range of Motion From Intraoperative to Final Recovery

Wide-Awake Tenolysis for Tendon Entrapment in a Distal Radial Epiphyseal Separation (Volar Displacement Type): A Case Report

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