Wide-awake extensor indicis proprius to extensor pollicis longus tendon transfer

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Anesthesiology

Background:

• Tendon transfers are crucial for restoring hand function after injury.
• Traditional methods often require general anesthesia and tourniquets, posing risks and limitations.
• Wide-awake local anesthesia offers a potentially safer and more patient-interactive alternative.

Purpose of the Study:

• To describe the technical steps for performing an extensor indicis proprius to extensor pollicis longus tendon transfer.
• To highlight the benefits of using wide-awake local anesthesia without a tourniquet.
• To emphasize the role of patient cooperation in achieving optimal surgical outcomes.

Main Methods:

• The procedure involves injecting local anesthesia (lidocaine) and a hemostatic agent (epinephrine).
• Patients remain awake and cooperative throughout the surgery, avoiding sedation and tourniquets.
• Surgeons utilize patient feedback on thumb movement to set precise tendon transfer tension.

Main Results:

• The technique allows for immediate assessment of tendon transfer tension by the awake patient.
• Patients' ability to actively participate enhances the accuracy of the transfer.
• This method simplifies the procedure by eliminating the need for sedation and tourniquets.

Conclusions:

• Wide-awake local anesthesia without a tourniquet is a feasible and effective approach for extensor indicis proprius to extensor pollicis longus tendon transfer.
• Patient engagement during the procedure leads to improved functional outcomes.
• This technique offers a valuable alternative for hand surgery, promoting patient comfort and cooperation.