ADVANTAGES OF WALANT VERSUS SEDATION AND TOURNIQUET IN EXTENSOR TENDON REPAIR OF THE FINGER

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  You can simulate the relative motion extension splint during WALANT surgery with a sterile tongue depressor.1–3 This will help you decide whether you need to add a wrist component to the Merritt splint. Wyndell Merritt′s relative motion extension splint has revolutionized management of lacerations at the proximal phalanx and dorsal hand levels (see Chapter 37) in the last few years. Patients can return to work with these very functional splints as early as a few days after surgery.

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  Clip 35-1 demonstrates that the relative motion extension splint decreases excursion in extensor tendon repair in the proximal finger. The relative motion extension splint keeps the MP joint of the affected finger more extended than the other MP joints. This takes the tension off the long extensors, even when fingers are actively flexing. (See also video clips in Chapter 37.)

  
  
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  You can simulate the relative motion flexion splint during WALANT boutonniere surgery or in clinic consultations with a sterile tongue depressor. The Merritt relative motion flexion splint has revolutionized acute and chronic boutonniere management in the last few years. Patients can return to work with these very functional splints.

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  Clip 35-2 shows Merritt relative motion flexion splinting for boutonniere deformity. The relative motion flexion splint keeps the MP joint of the affected finger more flexed than the MP joints of the adjacent fingers. This increased tension on the long extensors pulls the lateral bands dorsal to the axis of the PIP joint while taking the tension off the intrinsic volar pull on the same lateral bands.

  
  
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  WALANT takes many of the inconveniences of general and motor block anesthesia out of the management of fracture mallet injuries.

  
  
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  All of the general advantages listed in Chapter 2 apply to both the surgeon and the patient.

WHERE TO INJECT THE LOCAL ANESTHETIC FOR EXTENSOR TENDON REPAIR OF THE FINGER

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  See Chapter 1, Atlas, for more illustrations of the anatomy of diffusion of tumescent local anesthetic in the forearm, wrist, and hand.