Chapter 36 Extensor Tendon Repair of the Hand
ADVANTAGES OF WALANT VERSUS SEDATION AND TOURNIQUET IN EXTENSOR TENDON REPAIR OF THE HAND
You can see that that your repair is solid enough by watching the patient take the fingers through a full range of motion before you close the skin.
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 extensor tendon laceration of the proximal phalanx (see Clip 35-1 in Chapter 35) and dorsal hand management in the last few years. Patients can go back to work with these very functional splints as early as a few days after surgery, as shown in Clip 36-1.
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 repaired long extensor, even when fingers are actively flexing.
Patients get to see their finger movement restored during the surgery. They will remember this light at the end of the tunnel when they are working through the pain and stiffness of postoperative healing and therapy.
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 HAND
See Chapter 1, Atlas, for more illustrations of the anatomy of diffusion of tumescent local anesthetic in the forearm, wrist, and hand.