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Published on: September 2, 2025
Multiple tendon transfer under WALANT - A retrospective case series.
Zhi Yang Ng1, Leo Tsz-Ching Chau2, Camelia Qian Ying Tang3
1Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region.
Hand Surgery & Rehabilitation
|July 10, 2026
Summary
Multiple tendon transfers for nerve palsies are feasible and effective under Wide Awake Local Anesthesia No Tourniquet (WALANT) in hand surgery. This technique offers good functional outcomes with no need for revision surgery.
Area of Science:
- Orthopaedic Surgery
- Hand Surgery
- Microsurgery
Background:
- Wide Awake Local Anesthesia No Tourniquet (WALANT) is increasingly adopted in hand surgery.
- Limited literature exists on WALANT for multiple tendon transfers in nerve palsy cases.
- This study evaluates WALANT for multiple tendon transfers in nerve palsies.
Purpose of the Study:
- To report clinical and functional outcomes of multiple tendon transfers performed under WALANT.
- To assess the safety and efficacy of WALANT in complex hand reconstructions.
Main Methods:
- Retrospective recruitment of 14 patients with peripheral nerve palsies.
- Procedures performed between March 2015 and March 2025.
- WALANT technique utilized for multiple tendon transfers and ancillary procedures.
Main Results:
- 14 patients with radial, PIN, ulnar, and median nerve palsies treated.
- Average follow-up of 37 months with no secondary revisions.
- Mean improvement to 3.7 on the MRC scale post-transfer.
Conclusions:
- Multiple tendon transfers under WALANT are a viable option for nerve palsy reconstruction.
- WALANT facilitates complex hand surgeries with satisfactory functional recovery.
- This series represents the largest to date for multiple tendon transfers under WALANT.
