gms | German Medical Science

Objectives/Interrogation: To present our experience with the use of WALANT (Wide Awake Local Anaesthesia No Tourniquet) for tendon transfers.

Methods: We present nine cases operated during 2018 in three Hospitals (Table 1 [Tab. 1]).

Author (1) was the lead surgeon for all cases.

We present our injection method for each of these procedures.

All transfers were performed with 2.0 or 3.0 braided non absorbable suture using the side to side tendon weave as per Jan Friden. A temporary stay suture was placed for each transfer and passive tenodesis was used to check the tension. The patient was then asked to use the transfer muscle in order to check the tension. In a number cases, although the passive tenodesis tension appeared satisfactory the tension needed to be readjusted after assessment of active motion as tenodesis may not always be accurate for setting the tension [1].

All patients were referred for early protected active mobilization.

We present our outcomes based on patient satisfaction (questionnaire) and complications.

Results: One of our patients developed a wound breakdown due to postoperative infection that required surgical debridement. However his transfer was not compromised and his wound eventually healed.

Another patient suffered a rupture of the transfer (ECRB to Adductor pollicis using PL graft) 11 weeks post surgery.

All patients were very happy to see the outcome of their procedure on the table and this reassured them about their outcome. Also, rehabilitation was started on the table as patients were taught how to fire the transfers during surgery. No patient required sedation during surgery.

From a surgeon's perspective, the ability to witness the tension of the transfer during active range of motion was invaluable, making WALANT our preferred method of anaesthesia for carrying out tendon transfers.

Conclusion: WALANT is a safe method of anaesthesia for tendon transfer surgery and if a surgeon is proficient in administering it, then the benefits of active motion can lead to good outcomes and increased patient reassurance and satisfaction.