Extensor Indicis Proprius to Extensor Pollicis Longus Tendon Transfer under Local Anesthesia. Surgical Technique
Rupture of the extensor pollicis longus (EPL) tendon at the wrist has been described after fracture of the distal radius at Lister’s tubercle, in synovitis, tenosynovitis, or rheumatoid arthritis. The most common procedure for the treatment of irreparable ruptures of the extensor pollicis longus (EPL) tendon is the extensor indicis proprius (EIP) transfer. The main challenge of this technique is the correct tension setting of the transfer. The wide-awake technique allows patients to be awake during the operation and to retain full motor control of the hand. It provides the surgeon the ability to make clinical observations, adjust the tendon transfer tension according to active hand movement in order to make sure the transfer has the right tension before the skin closure. Hereby we present a technique for an EIP to EPL transfer for patients with irreparable rupture of the EPL tendon with the use of local anesthetic and tourniquet. This technique provides the surgeon the ability to assess properly the tension of the transfer by asking the patient to extend and flex his thumb during the operation.
2. Kim CH. Spontaneous Rupture of the Extensor Pollicis Longus Tendon. Arch Plast Surg. 2012;39(6):680-682. doi:10.5999/aps.2012.39.6.680.
3. Engkvist O, Lundborg G. Rupture of the extensor pollicis longus tendon after fracture of the lower end of the radius: a clinical and microangiographic study. Hand. 1979;11:76–86.
4. Roth KM, Blazar PE, Earp BE, et al. Incidence of extensor pollicis longus tendon rupture after nondisplaced distal radius fractures. J Hand Surg-Am. 2012;37:942–7. doi: 10.1016/j.jhsa.2012.02.006.
5. Bjorkman A, Jorgsholm P. Rupture of the extensor pollicis longus tendon: a study of aetiological factors. Scand J Plast Reconstr Surg Hand Surg. 2004;38:32–35.
6. Harvey FJ, Harvey PM. Three rare causes of extensor tendon rupture. J Hand Surg Am. 1989;14:957–962.
7. Choi JC, Kim WS, Na HY, et al. Spontaneous rupture of the extensor pollicis longus tendon in a tailor. Clin Orthop Surg. 2011;3:167–169.
8. Hoch J, Losch GM, Schrader M. Long-term results following reconstruction of the tendon of the extensor pollicis longus muscle by transposition of the tendon of the extensor indicis muscle. Handchir Mikrochir Plast Chir. 1988;20:93–96.
9. Lee JH, Cho YJ, Chung DW. A New Method to Control Tendon Tension in the Transfer of Extensor Indicis Proprius to Extensor Pollicis Longus Rupture. Ann Plast Surg. 2015 Dec;75(6):607-9.
10. Bezuhly M, Sparkes GL, Higgins A, Neumeister MW, Lalonde DH. Immediate thumb extension following extensor indicis proprius-to-extensor pollicis longus tendon transfer using the wide-awakeapproach. Plast Reconstr Surg. 2007 Apr 15;119(5):1507-12.
11. Lalonde DH. Wide- awake extensor indicis proprius to extensor pollicis longus tendon transfer. J Hand Surg Am. 2014 Nov;39(11):2297-9. doi: 10.1016/j.jhsa.2014.08.024. Epub 2014 Oct 3.
12. Frank SG, Lalonde DH. How acidic is the lidocaine we are injecting, and how much bicarbonate should we add? Can J Plast Surg. 2012;20(2):71e73.
13. Strazar AR, Leynes PG, Lalonde DH. Minimizing the pain of local anesthesia injection. Plast Reconstr Surg. 2013;132(3):675e684.
14. Low CK, Pereira BP, Chao VT. Optimum tensioning position for extensor indicis to extensor pollicis longus transfer. Clin Orthop Relat Res. 2001;388:225–232.
15. Lemmen MH, Schreuders TA, Stam HJ, et al. Evaluation of restoration of extensor pollicis function by transfer of the extensor indicis. J Hand Surg Br. 1999;24:46–49.
16. Magnussen PA, Harvey FJ, Tonkin MA. Extensor indicis proprius transfer for rupture of the extensor pollicis longus tendon. J Bone Joint Surg Br. 1990;72: 881–883.
17. Jung-Jun Hong, Ho-Jung Kang, M, Jong-ick Whang et al. 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. Plast Reconstr Surg. 2020 Mar;145(3):723-733
18. Nodwell T, Lalonde DH. How long does it take phentolamine to reverse adrenaline-induced vasoconstriction in the finger and hand? A prospective randomized blinded study: the Dalhousie project experimental phase. Can J Plast Surg. 2003;11(4):187e190.
Copyright (c) 2020 Acta Orthopaedica Et Traumatologica Hellenica
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.