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Wide-Awake Primary Flexor Tendon Repair, Tenolysis, and Tendon Transfer.

Tang JB - Clin Orthop Surg (2015)

Bottom Line: This method allows the tendon to move actively during surgery to test tendon function intraoperatively and to ensure the tendon is properly repaired before leaving the operating table.I applied this method to primary flexor tendon repair in zone 1 or 2, tenolysis, and tendon transfer, and found this approach makes tendon surgery easier and more reliable.This article describes the method that I have used for tendon surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, China.

ABSTRACT
Tendon surgery is unique because it should ensure tendon gliding after surgery. Tendon surgery now can be performed under local anesthesia without tourniquet, by injecting epinephrine mixed with lidocaine, to achieve vasoconstriction in the area of surgery. This method allows the tendon to move actively during surgery to test tendon function intraoperatively and to ensure the tendon is properly repaired before leaving the operating table. I applied this method to primary flexor tendon repair in zone 1 or 2, tenolysis, and tendon transfer, and found this approach makes tendon surgery easier and more reliable. This article describes the method that I have used for tendon surgery.

No MeSH data available.


Related in: MedlinePlus

Wide-awake local anesthesia for a case with a complete zone 2 flexor tendon cut in the middle finger. (A) The first injection (10-15 mL) was performed in the most proximal part of the likely dissection to block the nerves distally. (B) Fifteen minutes after the first injection, the second injection (2 mL) was performed subcutaneously at the palmar digital crease between both digital nerves. (C) The third injection (2 mL) was performed immediately after the second injection under the skin at the digital crease of the proximal interphalangeal joint between both digital nerves. (D) The final injection (1 mL) was performed immediately after the third injection under the skin at the digital crease of the distal interphalangeal joint between both digital nerves.
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Figure 2: Wide-awake local anesthesia for a case with a complete zone 2 flexor tendon cut in the middle finger. (A) The first injection (10-15 mL) was performed in the most proximal part of the likely dissection to block the nerves distally. (B) Fifteen minutes after the first injection, the second injection (2 mL) was performed subcutaneously at the palmar digital crease between both digital nerves. (C) The third injection (2 mL) was performed immediately after the second injection under the skin at the digital crease of the proximal interphalangeal joint between both digital nerves. (D) The final injection (1 mL) was performed immediately after the third injection under the skin at the digital crease of the distal interphalangeal joint between both digital nerves.

Mentions: In making the first injection, we insert the needle perpendicular to the skin into the subcutaneous fat to reduce pain of injection.6) Then the syringe is stabilized with fingers propped on the skin to avoid needle wobble. We inject the first 0.5 mL slowly (5 seconds) and then pause. Wait 15 to 45 seconds until the patient tells us that the sting is gone. Then, we proceed to inject the rest of infiltration very slowly (more than 5 minutes) without moving the needle (Fig. 2A). Sometimes, I make this first injection in a quicker fashion than I described above and inject continuously in the way that we all use for local anesthesia, if the patient tolerates well.


Wide-Awake Primary Flexor Tendon Repair, Tenolysis, and Tendon Transfer.

Tang JB - Clin Orthop Surg (2015)

Wide-awake local anesthesia for a case with a complete zone 2 flexor tendon cut in the middle finger. (A) The first injection (10-15 mL) was performed in the most proximal part of the likely dissection to block the nerves distally. (B) Fifteen minutes after the first injection, the second injection (2 mL) was performed subcutaneously at the palmar digital crease between both digital nerves. (C) The third injection (2 mL) was performed immediately after the second injection under the skin at the digital crease of the proximal interphalangeal joint between both digital nerves. (D) The final injection (1 mL) was performed immediately after the third injection under the skin at the digital crease of the distal interphalangeal joint between both digital nerves.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553273&req=5

Figure 2: Wide-awake local anesthesia for a case with a complete zone 2 flexor tendon cut in the middle finger. (A) The first injection (10-15 mL) was performed in the most proximal part of the likely dissection to block the nerves distally. (B) Fifteen minutes after the first injection, the second injection (2 mL) was performed subcutaneously at the palmar digital crease between both digital nerves. (C) The third injection (2 mL) was performed immediately after the second injection under the skin at the digital crease of the proximal interphalangeal joint between both digital nerves. (D) The final injection (1 mL) was performed immediately after the third injection under the skin at the digital crease of the distal interphalangeal joint between both digital nerves.
Mentions: In making the first injection, we insert the needle perpendicular to the skin into the subcutaneous fat to reduce pain of injection.6) Then the syringe is stabilized with fingers propped on the skin to avoid needle wobble. We inject the first 0.5 mL slowly (5 seconds) and then pause. Wait 15 to 45 seconds until the patient tells us that the sting is gone. Then, we proceed to inject the rest of infiltration very slowly (more than 5 minutes) without moving the needle (Fig. 2A). Sometimes, I make this first injection in a quicker fashion than I described above and inject continuously in the way that we all use for local anesthesia, if the patient tolerates well.

Bottom Line: This method allows the tendon to move actively during surgery to test tendon function intraoperatively and to ensure the tendon is properly repaired before leaving the operating table.I applied this method to primary flexor tendon repair in zone 1 or 2, tenolysis, and tendon transfer, and found this approach makes tendon surgery easier and more reliable.This article describes the method that I have used for tendon surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, China.

ABSTRACT
Tendon surgery is unique because it should ensure tendon gliding after surgery. Tendon surgery now can be performed under local anesthesia without tourniquet, by injecting epinephrine mixed with lidocaine, to achieve vasoconstriction in the area of surgery. This method allows the tendon to move actively during surgery to test tendon function intraoperatively and to ensure the tendon is properly repaired before leaving the operating table. I applied this method to primary flexor tendon repair in zone 1 or 2, tenolysis, and tendon transfer, and found this approach makes tendon surgery easier and more reliable. This article describes the method that I have used for tendon surgery.

No MeSH data available.


Related in: MedlinePlus