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American Association for Hand Surgery

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Functional Outcomes of Flexor Tendon Repair in the Fingers: A Comparison of Wide Awake Local Anesthesia versus Traditional Anesthesia
Clay Townsend, MD1, Tyler W. Henry, MD2, Jonas Matzon, MD3, Daniel Allan Seigerman, MD4, Samir Sodha, MD5 and Pedro K Beredjiklian, M.D.3, (1)Rothman Institute at Thomas Jefferson University Hopsital, Philadelphia, PA, (2)Sidney Kimmel Medical College at Jefferson University, Philadelphia, PA, (3)Rothman Institute, Philadelphia, PA, (4)Hand and Upper Extremity Surgery, Rothman Institute/ Jefferson Medical College, Philadelphia, PA, (5)Rothman Institute, philadelphia, PA

Introduction
Flexor tendon lacerations in the fingers (zone I and II) are challenging injuries that can be repaired using the wide-awake local anesthesia no tourniquet (WALANT) technique or under traditional anesthesia (TA). The purpose of our study was to compare the functional outcomes and complication rates of patients undergoing flexor tendon repair under WALANT versus TA.
Materials and Methods
All patients who underwent a primary flexor tendon repair in zone 1 and 2 without tendon graft for closed avulsions or open lacerations between 2015 and 2019 were identified. Electronic medical records were reviewed to record and compare patient demographics, range of motion, functional outcomes, complications, and reoperations.
Results
Sixty-five zone I (N=21) or II (N=44) flexor tendon repairs were included in final analysis. Twenty-three of these patients were in the WALANT group, and 42 were in the TA group. There were no other statistical differences in mean age, length of follow-up, proportion of injured digits, or zone of injury between the two groups. The final qDASH score in the WALANT group was 17.2 (SD 14.4) vs 23.3 (SD 18.5) in the TA group. There were no statistical differences between the groups with any final ROM parameters, grip strength, or VAS pain scores at final follow-up. The WALANT group was found to have a higher reoperation rate (26.1% vs 7.1%; p<.05) than the TA group.
Conclusions
This study represents one of the first clinical studies reporting outcomes of flexor tendon repairs performed under local anesthesia. Overall, we found no difference in rupture rates, ROM, and functional outcomes following zone I and II flexor tendon repairs when performed under WALANT versus TA.


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