Chapter 39 Tendon Transfers
ADVANTAGES OF WALANT VERSUS SEDATION AND TOURNIQUET IN TENDON TRANSFERS
The biggest advantage of using the wide awake approach for tendon transfer is getting the correct tension on the transfer. It is easy to make a tendon transfer too tight or too loose. You can see that your tendon transfer tension is correct by watching the patient take the thumb or finger through a full range of motion before you close the skin.1 You can tighten or loosen the transfer and have the comfortable, pain-free patient retest the tension. Both you and your patient know the tension is right before you close the skin.
In Clip 39-2 Dr. Robert Szabo performs a wide awake EI to EPL transfer with intraoperative testing to make sure the tendon transfer is right.
You can explain to your patient how to activate the transfer during the surgery. Some patients need to think that they are lifting their index finger to get their thumb to move with extensor indicis (EI) to extensor pollicis longus (EPL) tendon transfer. Most patients are able to extend the thumb without initially thinking about lifting the index finger.
Patients are able to see that their transfer is working during surgery. They are motivated to achieve the result they know they will get if they work at it after surgery.
In Clip 39-3 Dr. Mark Baratz demonstrates a patient watching herself extend her thumb in the procedure room.
All of the general advantages listed in Chapter 2 apply to both the surgeon and the patient.
WHERE TO INJECT THE LOCAL ANESTHETIC FOR EI TO EPL TRANSFER
WHERE TO INJECT THE LOCAL ANESTHETIC FOR FLEXOR DIGITORUM SUPERFICIALIS 3 OR 4 (FDS3 OR FDS4) TO THE FLEXOR POLLICIS LONGUS (FPL) TRANSFER
See Chapter 1, Atlas, for more illustrations of the anatomy of diffusion of tumescent local anesthetic in the forearm, wrist, and hand.