Document Detail

Immediate thumb extension following extensor indicis proprius-to-extensor pollicis longus tendon transfer using the wide-awake approach.
MedLine Citation:
PMID:  17415245     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The elective use of low-dose epinephrine in hand surgery has allowed for the performance of simple operative procedures with tourniquet-free pure local anesthesia (the wide-awake approach). The absence of general anesthesia or sedation has, in turn, allowed for the observation of how quickly the sensorimotor cortex adapts following procedures such as tendon transfer.
METHODS: Seven patients underwent a wide-awake transfer of the extensor indicis proprius to the extensor pollicis longus between February of 2002 and May of 2005 for restoration of thumb extension using local lidocaine with epinephrine alone. One of the seven patients experienced rupture of the initial transfer, necessitating transfer of the extensor carpi radialis longus to the extensor pollicis longus using the wide-awake approach.
RESULTS: All seven patients were able to extend their thumbs fully by means of extensor indicis proprius intraoperatively immediately following transfer suture placement. Restoration of function was not ablated by loss of proprioception or visual feedback. At a mean follow-up of 15 months, thumb extension was restored to within normal limits in the affected thumb, with a slight decrease in grip and tripod pinch strength.
CONCLUSIONS: The wide-awake approach has allowed the authors to adjust tendon transfer tension with active movement before skin closure without the risks associated with general or regional anesthesia. In addition, it has allowed them to observe immediate cortical adaptation in the context of a simple tendon transfer. The authors hypothesize that the brain's ability to immediately use extensor indicis proprius for thumb extension stems from the activation of preexisting synergistic cortical finger movement programs.
Michael Bezuhly; Gerald L Sparkes; Amanda Higgins; Michael W Neumeister; Donald H Lalonde
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Plastic and reconstructive surgery     Volume:  119     ISSN:  1529-4242     ISO Abbreviation:  Plast. Reconstr. Surg.     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-04-06     Completed Date:  2007-05-03     Revised Date:  2014-10-13    
Medline Journal Info:
Nlm Unique ID:  1306050     Medline TA:  Plast Reconstr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1507-12     Citation Subset:  AIM; IM    
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MeSH Terms
Anesthetics, Local / therapeutic use*
Epinephrine / therapeutic use*
Lidocaine / therapeutic use*
Middle Aged
Monitoring, Intraoperative
Tendon Injuries / surgery*
Tendon Transfer*
Thumb / surgery*
Reg. No./Substance:
0/Anesthetics, Local; 98PI200987/Lidocaine; YKH834O4BH/Epinephrine
Comment In:
Plast Reconstr Surg. 2008 Feb;121(2):688; author reply 688-9   [PMID:  18301008 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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