Immediate thumb extension following extensor indicis proprius-to-extensor pollicis longus tendon transfer using the wide-awake approach
Immediate thumb extension following extensor indicis proprius-to-extensor pollicis longus tendon transfer using the wide-awake approach
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DOI：
10.1097/01.prs.0000256071.00235.d0
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发表时间：
2007-04-15
影响因子：
3.6
通讯作者：
Lalonde, Donald H.
中科院分区：
文献类型：
--
作者：
Bezuhly, Michael;Sparkes, Gerald L.;Lalonde, Donald H.
背景：在手部外科手术中选择性使用小剂量肾上腺素，使得可以在不使用止血带的纯局部麻醉(广醒手术)下进行简单的手术操作。在没有全身麻醉或镇静的情况下，可以观察感觉运动皮质在肌腱移位等过程中适应的速度。方法：2002年2月至2005年5月，7例患者在清醒的情况下将示指固有肌伸肌移位至拇长伸肌，仅使用局部利多卡因加肾上腺素恢复拇指伸展功能。结果：7例患者均能在移植缝合后即刻通过食指固有伸肌充分伸展拇指。功能的恢复不会因为本体感觉或视觉反馈的丧失而消融。平均随访15个月，患侧拇指伸展恢复到正常范围，握力和三脚架握力略有下降。结论：大觉醒手术可以在缝合皮肤前通过主动活动来调整肌腱传递张力，而不存在全身麻醉或区域麻醉的风险。此外，它还允许他们在简单的肌腱转移的情况下观察立即的皮质适应。作者假设，大脑立即使用食指固有伸肌进行拇指伸展的能力源于激活先前存在的协同皮质手指运动程序。
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.