Chapter 39 Tendon Transfers



10.1055/b-0037-142210

Chapter 39 Tendon Transfers

Donald H. Lalonde, Robert M. Szabo, Mark E. Baratz

ADVANTAGES OF WALANT VERSUS SEDATION AND TOURNIQUET IN TENDON TRANSFERS

Clip 39-1 EI to EPL: getting the transfer tension right; clinical experience.



  • 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.

Clip 39-2 Dr. Robert Szabo performs a wide awake EI to EPL transfer.



  • 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.

Clip 39-3 Dr. Mark Baratz demonstrates a patient watching herself extend her thumb.


WHERE TO INJECT THE LOCAL ANESTHETIC FOR EI TO EPL TRANSFER

Inject 30 to 40 ml of 1% lidocaine with 1:100,000 epinephrine buffered with 3 to 4 ml of 8.4% bicarbonate (1 ml of sodium bicarbonate for each 10 ml of 1% lidocaine with 1:100,000 epinephrine). The dotted red lines are the possible incisions.


WHERE TO INJECT THE LOCAL ANESTHETIC FOR FLEXOR DIGITORUM SUPERFICIALIS 3 OR 4 (FDS3 OR FDS4) TO THE FLEXOR POLLICIS LONGUS (FPL) TRANSFER

Inject 50 to 100 ml of 0.5% lidocaine with 1:200,000 epinephrine buffered with 10:1 8.4% sodium bicarbonate. Add 10 ml 0.5% bupivacaine with 1:200,000 epinephrine to the total injectate in cases anticipated to last more than 2½ hours, in case the effects of the lidocaine begin to wear off.



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

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May 29, 2020 | Posted by in ORTHOPEDIC | Comments Off on Chapter 39 Tendon Transfers
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