Outcomes of Zone II Flexor Tendon Repair Under General Versus Wide Awake Local Anesthesia: A Randomized Controlled...

Area of Science:

• Orthopedic Surgery
• Anesthesiology
• Hand Surgery

Background:

• Wide awake local anesthesia no tourniquet (WALANT) is increasingly utilized for flexor tendon repair.
• General anesthesia (GA) is the traditional method for these procedures.

Purpose of the Study:

• To compare the efficacy of WALANT versus GA for zone II flexor tendon repair.
• To determine if WALANT offers superior functional outcomes, lower rupture rates, or improved patient-reported results compared to GA.

Main Methods:

• A randomized controlled trial included 86 digits undergoing zone II flexor tendon repair.
• Digits were randomized to either WALANT or GA, with all surgeries performed by a single surgeon.
• Outcomes assessed at 6 months included functional recovery (Strickland and Glogovac criteria), rupture rate, complications, and DASH scores.

Main Results:

• Analysis included 43 digits in the WALANT group and 40 in the GA group.
• Excellent or good outcomes were achieved in 49% (WALANT) and 56% (GA), a non-statistically significant difference.
• Rupture rates were identical (two digits in each group), and average DASH scores were 12.9 (WALANT) and 8.4 (GA).

Conclusions:

• WALANT is not demonstrably superior to GA for zone II flexor tendon repair in terms of function, rupture rates, or patient-reported outcomes.
• Both WALANT and GA are viable options when supported by careful patient selection, precise surgical technique, and diligent hand therapy.