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Erschienen in:
01.12.2024 | Original Paper
Flexor digitorum superficialis tendon transfer to extensor pollicis longus in the absence of palmaris longus tendon: a wide-awake anaesthesia approach
Erschienen in: European Journal of Plastic Surgery | Ausgabe 1/2024
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Background
The absence of the palmaris longus tendon poses a challenge in cases of long-standing radial nerve palsy. This study aims to evaluate the outcomes of using the flexor digitorum superficialis (FDS) tendon of the ring finger for transfer to the extensor pollicis longus (EPL) tendon under wide-awake local anesthesia with no tourniquet (WALANT).
Methods
A retrospective review of 12 patients with unrecovered radial nerve palsy who underwent FDS transfer to EPL, pronator teres to extensor carpi radialis brevis, and flexor carpi radialis transfer to the extensor digitorum communis under WALANT between 2019 and 2023 was conducted. Functional outcomes were assessed using a modified Bincaz score.
Results
The mean age of the patients was 42 years (range 28–55). All patients achieved a good score in functional outcomes. The mean Visual Analog Scale (VAS) score was 0.75 (range, 0–2). Most patients experienced immediate postoperative comfort, with only two reporting mild pain during the radial periosteum injection. Notably, none of the patients required additional analgesics or sedation during the procedure. All patients exhibited successful thumb extension, finger extension, and wrist dorsiflexion, indicating the adaptability of brain plasticity to tendon transfer and the feasibility of WALANT. Age, gender, side, and treatment delay did not significantly impact functional outcomes.
Conclusions
The FDS ring finger transfer to EPL in the absence of the palmaris longus tendon proves to be an effective surgical approach, yielding favorable outcomes. Wide-awake anesthesia with no tourniquet offers advantages such as intraoperative tension adjustment and enables patient participation in rehabilitation, thereby enhancing surgeon confidence for initiating early rehabilitation.
Level of Evidence:
Level IV, therapeutic study.