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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

Authors
 JungJun Hong  ;  Ho-Jung Kang  ;  Jong-Ick Whang  ;  Seung-Yong Sung  ;  Sung-Hoon Kim  ;  Sung-Chul Shin  ;  Si-Nae Kim  ;  Ji-Sup Kim 
Citation
 PLASTIC AND RECONSTRUCTIVE SURGERY, Vol.145(3) : 723-733, 2020-03 
Journal Title
 PLASTIC AND RECONSTRUCTIVE SURGERY 
ISSN
 0032-1052 
Issue Date
2020-03
MeSH
Adult ; Aged ; Anesthesia, General ; Anesthesia, Local ; Chronic Disease / therapy ; Female ; Finger Injuries / surgery* ; Finger Joint / surgery ; Follow-Up Studies ; Humans ; Intraoperative Care / methods* ; Male ; Metacarpophalangeal Joint / surgery ; Middle Aged ; Prospective Studies ; Range of Motion, Articular ; Retrospective Studies ; Rupture / surgery* ; Tendon Injuries / surgery* ; Tendon Transfer / adverse effects ; Tendon Transfer / methods* ; Thumb ; Treatment Outcome ; Wakefulness*
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.
Full Text
https://insights.ovid.com/pubmed?pmid=32097314
DOI
10.1097/PRS.0000000000006611
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Ho Jung(강호정) ORCID logo https://orcid.org/0000-0003-0273-1264
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/181519
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