Wide-Awake Flexor Tendon Repair Under Tumescent Injection

Abstract

Background. Flexor tendon injuries are frequent, due to variable hand activities, and the repair is challenging to hand surgeons, especially in zone II, because of the coexistence of two tendons within a tight fibro-osseous tunnel. Flexor tendon repair under tumescent infiltration provides anesthesia and a bloodless field, so that no tourniquet or sedation is needed. Aim of study. The goal of this study was to identify a surgical adjustment and intraoperative total active movement examination of the repaired tendon so that no gapping is formed, and smooth gliding is obtained, avoiding tendon rupture and producing an optimal range of motion. Patients and method. From January 2016 to April 2017, 9 patients (17 tendons), with a mean age of 31.8 years, presented within 3 to 14 days of injury to zone I or zone II of their flexor tendons. Tendon repair was done under tumescent infiltration (lidocaine 1% with adrenaline 1:200,000) only, with no tourniquet or sedation, and with an intraoperative total active movement examination. Result. After 6 months of follow up, all the patients had excellent range of motion according to the Boyes outcome scale, and none showed signs of postoperative tendon rupture. Conclusion. Tumescent infiltration for flexor tendon repair allows intraoperative surgical adjustment and total active movement examination, which will minimize postoperative rupture and adhesion. This procedure will also facilitate the surgeon’s work by eliminating the need for general anesthesia or sedation; however, this procedure is not applicable for children, major trauma, or those who are mentally challenged.