AAHS Annual Meeting
Back to main AAHS site
Annual Meeting Home
Past & Future Meetings

Back to Annual Meeting Posters

Five and a Half Week Old Flexor Pollicis Longus Laceration: Wide Awake Primary Repair, FDS Transfer, or Palmaris Longus Tendon Graft?
Peter G. Davison, BSc, MD; Donald H. Lalonde, BSc, MSc, MD; Dalhousie University
Saint John Regional Hospital, Saint John, NB, Canada


A primary tendon repair is the standard of practice for acute injuries, where acuteis generally considered up to 2 or 3 weeks post-injury. Beyond this, a primary repair is often not possible and tendon reconstruction using a tendon graft or tendon transfer is required.

Methods and Materials

This 6-minute video illustrates the reconstruction of a 5.5 week old FPL laceration, using the wide awake technique. Pre-operative marking and 60 cc of 0.5 % buffered lidocaine with 1:200,000 epinephrine was injected for repair, as well as for palmaris tendon graft and long finger FDS tendon transfer as back up plans, in the event that a primary repair was not possible. The decision would be made intra-operatively, based on the status of the cut FPL tendon and the active tendon excursion in the comfortable tourniquet free awake patient.


The proximal tendon had retracted well proximal to the zone of injury. However, a 3cm pseudotendon was discovered within the proximal flexor sheath. It was adherent to the proximal tendon stump. The presence of the pseudotendon allowed atraumatic retrieval and advancement of the proximal tendon stump into the operative field, without any proximal incisions, or proximal extension of the incision into the carpal tunnel. Primary repair was performed.

The thumb was immobilized for 4 weeks post-operatively and ended up with a good result in spite of some bowstringing.


A primary tendon repair was possible and was performed in this case. If the proximal end of the tendon had been too short for primary repair but had good excursion, we could have harvested a palmaris longus tendon graft and inset it with appropriate tension, as we would have been able to see the patient move it intraoperatively. If the proximal tendon had demonstrated very poor excursion, we also had injected local anesthesia for the possibility of FDS long finger tendon transfer to FPL. Again, we would have been able to test the tension of the transfer with active movement intraoperatively.

We propose that in most delayed flexor tendon lacerations, this method of injecting local anesthesia in a wide awake patient is applicable. It provides the option to perform any of tendon repair, graft, or transfer depending on the intraoperative active tendon length and excursion, as well as the ability to set the optimal tension of whichever reconstruction is chosen.

Back to Annual Meeting Posters


© 2020 American Association for Hand Surgery. Privacy Policy.