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Wide-Awake Flexor Pollicis Longus Tendon Reconstruction with Evaluation of the Active Voluntary Contraction of the Ruptured Muscle-Tendon

Zukawa, Mineyuki, M.D.; Osada, Ryusuke, M.D., Ph.D.; Makino, Hiroto, M.D., Ph.D.; Kimura, Tomoatsu, M.D., Ph.D.

Plastic and Reconstructive Surgery: January 2019 - Volume 143 - Issue 1 - p 176–180
doi: 10.1097/PRS.0000000000005092
Hand/Peripheral Nerve: Ideas and Innovations
Discussion
Coding Perspective

Summary: The purpose of this study was to investigate the clinical outcome of the wide-awake tendon reconstruction for chronic rupture of the flexor pollicis longus tendon with evaluation of the voluntary active contraction distance of the ruptured musculotendinous unit. Eleven consecutive patients underwent tendon reconstruction under wide-awake surgery. If the total of the passive distraction distance and the active contraction distance of the ruptured flexor pollicis longus musculotendinous unit was greater than 30 mm, tendon grafting was performed. If not, tendon transfer was performed using the fourth flexor digitorum superficialis. Patients were evaluated with total active motion before surgery, during surgery, and in final follow-up and subjectively surveyed with quick Disabilities of the Arm, Shoulder and Hand scores. The final outcomes of tendon grafting and of tendon transfer were compared. Tendon grafting was performed in four patients, and tendon transfer was performed in seven patients. The final follow-up total active motion was 84.3 ± 12.7 percent in the tendon transfer group and 80.7 ± 10.2 percent in the tendon grafting group. There were no significant differences between the two groups in the final follow-up total active motion percentage and quick Disabilities of the Arm, Shoulder and Hand scores. The functional outcomes of both tendon grafting and tendon transfer were acceptable based on evaluating the active contraction distance and passive distraction distance of the ruptured musculotendinous unit during wide-awake surgery. Evaluating these distances may be a useful index to assess the ruptured musculotendinous unit. The greatest advantage of the wide-awake tendon reconstruction is that surgeons can evaluate the ruptured musculotendinous unit and measure total active motion during surgery while adjusting suture tension.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Coding Perspective for This Article is on Page 179.

Toyama-City, Japan

From the Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama.

Received for publication January 19, 2018; accepted July 12, 2018.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Mineyuki Zukawa, M.D., Department of Orthopaedic Surgery, Faculty of Medicine, Toyama University, 2630, Sugitani, Toyama 930-0194, Japan, zukawa@med.u-toyama.ac.jp

©2019American Society of Plastic Surgeons