gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Using wide-awake local anesthesia in the secondary reconstructive surgery after wrist replantation

Meeting Abstract

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  • presenting/speaker Dun Hao Chang - Far Eastern Memorial Hospital, New Taipei City, Taiwan
  • Chi Ying Hsieh - Far Eastern Memorial Hospital, New Taipei City, Taiwan
  • Ke Chung Chang - Far Eastern Memorial Hospital, New Taipei City, Taiwan

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1368

doi: 10.3205/19ifssh0658, urn:nbn:de:0183-19ifssh06583

Published: February 6, 2020

© 2020 Chang et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

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Objectives/Interrogation: Previous studies have shown that tenolysis and tendon transfer were the most common secondary procedures following distal forearm and wrist amputations. Recently, wide awake local anesthesia with no tourniquet (WALANT) became more and more popular in hand tendon surgery because it can ensure tendon gliding and adequate tension during the surgery. However, little literature has addressed the safety and effectiveness of WALANT in secondary reconstructive surgery in patients who have had a wrist replantation.

Methods: We report a 17-year-old young man who suffered a nearly total amputation at left radiocarpal joint. He underwent successful replantation. But misconnection of flexor digitorum superficialis (FDS) tendons among thumb, index and middle fingers was found post-operatively. He underwent tenolysis and corrective tendon repair at 1.5 months after replantation. At 6 months post-replantation, he also underwent tendon shortening, pulley reconstruction for the extensor pollicis longus (EPL) tendon bowstringing and subsequent extension lag.

Results: These two operations were done successfully under WALANT, and we injected 80cc and 40 cc 0.5% lidocaine with 1:200,000 epinephrine respectively. During the operation, correct flexor tendon repair was revised and checked by asking the patient to bend his fingers one by one. And the tension of EPL tendon after shortening was also adjusted by intraoperative active extension. The hand and finger circulation remained well post-operatively, and the finger flexion and thumb extension function had achieved satisfactory improvement at the 18-month follow up. We are going to demonstrate with videos the way we injected the local anesthetics and the process of the surgery.

Conclusion: WALANT allows the tendon to move actively and test tendon function intraoperatively ensuring the tendon is properly repaired before leaving the operating table. It is also safe and feasible for patients who have had replantation before.