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Comparison of the Wide-Awake Approach and Conventional Approach in Extensor Indicis Proprius–to–Extensor Pollicis Longus Tendon Transfer for Chronic Extensor Pollicis Longus Rupture

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Title: Comparison of the Wide-Awake Approach and Conventional Approach in Extensor Indicis Proprius–to–Extensor Pollicis Longus Tendon Transfer for Chronic Extensor Pollicis Longus Rupture
Authors: Sunghoon Kim, Jong-ick Whang, Ho Jung Kang, Jung-Jun Hong, Sinae Kim, Seung-Yong Sung, Sung Chul Shin, Jisup Kim
Contributors: JungJun Hong, Ho-Jung Kang, Jong-Ick Whang, Seung-Yong Sung, Sung-Hoon Kim, Sung-Chul Shin, Si-Nae Kim, Ji-Sup Kim, Kang, Ho Jung
Source: Plastic & Reconstructive Surgery. 145:723-733
Publisher Information: Ovid Technologies (Wolters Kluwer Health), 2020.
Publication Year: 2020
Subject Terms: Range of Motion, Adult, Male, Tendon Transfer / adverse effects, Tendon Transfer, Chronic Disease / therapy, Rupture / surgery, Anesthesia, General, Metacarpophalangeal Joint, 03 medical and health sciences, 0302 clinical medicine, Tendon Injuries, Finger Joint, Finger Injuries, Humans, Anesthesia, Intraoperative Care / methods, Prospective Studies, Range of Motion, Articular, General, Metacarpophalangeal Joint / surgery, Aged, Retrospective Studies, Rupture, Intraoperative Care, Finger Joint / surgery, Wakefulness, Middle Aged, Finger Injuries / surgery, Tendon Injuries / surgery, Treatment Outcome, Local, Thumb, Chronic Disease, Female, Tendon Transfer / methods, Articular, Anesthesia, Local, Follow-Up Studies
Description: Background: The wide-awake approach enables surgeons to perform optimal tensioning of a transferred tendon intraoperatively. The authors hypothesized that the extensor indicis proprius–to–extensor pollicis longus tendon transfer using the wide-awake approach would yield better results than conventional surgery. Methods: A retrospective analysis was performed of the prospectively collected data of 29 consecutive patients who underwent extensor indicis proprius–to–extensor pollicis longus tendon transfer. Patients were treated with the wide-awake approach (group A, n = 11) and conventional surgery under general anesthesia (group B, n = 18). The groups were compared retrospectively for thumb interphalangeal and metacarpophalangeal joint motion, grip and pinch strength, specific extensor indicis proprius–to–extensor pollicis longus evaluation method (SEEM), and Disabilities of the Arm, Shoulder and Hand questionnaire score at 6 weeks and 2, 4, 6, and 12 months postoperatively. Results: Group A showed significantly better interphalangeal joint flexion and total arc of motion at 6 weeks and 2, 4, and 6 months, and significantly better metacarpophalangeal joint flexion and total arc of motion at all time points. Interphalangeal and metacarpophalangeal joint extension showed no difference at all time points. Group A showed significantly better specific extensor indicis proprius–to–extensor pollicis longus evaluation method scores at 2 and 4 months, and Disabilities of the Arm, Shoulder and Hand questionnaire scores at 4, 6, and 12 months. Grip and pinch strength showed no difference at all time points. The complication rate and duration until return to work were not different between groups. Conclusion: Compared with the conventional approach, the wide-awake approach showed significantly better results in the thumb’s range of motion and functional outcomes, especially in the early postoperative periods. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Document Type: Article
Language: English
ISSN: 0032-1052
DOI: 10.1097/prs.0000000000006611
Access URL: https://pubmed.ncbi.nlm.nih.gov/32097314
https://ir.ymlib.yonsei.ac.kr/handle/22282913/181519
https://pubmed.ncbi.nlm.nih.gov/32097314/
https://www.ncbi.nlm.nih.gov/pubmed/32097314
https://insights.ovid.com/pubmed?pmid=32097314
http://www.ncbi.nlm.nih.gov/pubmed/31876864
https://journals.lww.com/10.1097/PRS.0000000000006611
Rights: CC BY NC ND
Accession Number: edsair.doi.dedup.....4fdb6c9a7be04171f69f136b7d12b116
Database: OpenAIRE
Description
Abstract:Background: The wide-awake approach enables surgeons to perform optimal tensioning of a transferred tendon intraoperatively. The authors hypothesized that the extensor indicis proprius–to–extensor pollicis longus tendon transfer using the wide-awake approach would yield better results than conventional surgery. Methods: A retrospective analysis was performed of the prospectively collected data of 29 consecutive patients who underwent extensor indicis proprius–to–extensor pollicis longus tendon transfer. Patients were treated with the wide-awake approach (group A, n = 11) and conventional surgery under general anesthesia (group B, n = 18). The groups were compared retrospectively for thumb interphalangeal and metacarpophalangeal joint motion, grip and pinch strength, specific extensor indicis proprius–to–extensor pollicis longus evaluation method (SEEM), and Disabilities of the Arm, Shoulder and Hand questionnaire score at 6 weeks and 2, 4, 6, and 12 months postoperatively. Results: Group A showed significantly better interphalangeal joint flexion and total arc of motion at 6 weeks and 2, 4, and 6 months, and significantly better metacarpophalangeal joint flexion and total arc of motion at all time points. Interphalangeal and metacarpophalangeal joint extension showed no difference at all time points. Group A showed significantly better specific extensor indicis proprius–to–extensor pollicis longus evaluation method scores at 2 and 4 months, and Disabilities of the Arm, Shoulder and Hand questionnaire scores at 4, 6, and 12 months. Grip and pinch strength showed no difference at all time points. The complication rate and duration until return to work were not different between groups. Conclusion: Compared with the conventional approach, the wide-awake approach showed significantly better results in the thumb’s range of motion and functional outcomes, especially in the early postoperative periods. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
ISSN:00321052
DOI:10.1097/prs.0000000000006611