Avoiding Flexor Tendon Repair Rupture with Intraoperative Total Active Movement Examination

Author(s): Higgins A, Lalonde DH, Bell M, McKee D, Lalonde JF

Source: Plast Reconstr Surg 126: 941-45, 2010.

Summary:

Flexor tendon rupture is a known complication with poor outcome after flexor tendon repair with rates fluctuating between 4-17% in standard literature using general or regional block anesthesia for repairs.  In this retrospective study of 102 patients, 173 flexor tendons were repaired using a wide awake, tourniquet free technique.  Only lidocaine with epinephrine was used for anesthesia and hemostasis.  Outcomes were determined by direct clinical follow-up or telephone interview and “known” outcomes were reported in 68 patients with 122 repaired tendons.  The authors’ combined rupture rate from 2 clinical sites utilizing this technique is 3% of tendons, 4% of patients (4 ruptures in 3 patients).  All ruptures were from repeat traumatic episodes in the postoperative period. 

The authors also were able to intra-operatively identify 7 tendon repairs with gapping at the repair site by having the patients active flex the involved digits at the time of repair.  These repairs were revised and demonstrated no gapping upon repeat active motion intraoperatively. None of these patients subsequently ruptured their repairs. 

This article is interesting in that it evaluates tendon repairs in the thumb and digits under local anesthesia for the sole purpose of allowing intra-operative active motion to check repair site integrity.  It utilizes fewer anesthetic resources and may be able to identify those at higher risk of repair rupture by identifying repair site gaps.  The main weakness in the study is the dependence upon phone interviews for follow-up instead of physician evaluation for a significant number or participants. 

A video is linked from this article on the PRS website in which viewers may observe the wide-awake flexor tendon repair being performed, as well as active gapping of the repair site during active motion with its subsequent correction.