Bamal Rahul, Alnobani Omar, Bastouros Ehab, Nolan Grant, Morris Elaine, Griffiths Sarah, Bell David
Plastic Surgery, Whiston Hospital, Prescot, GBR.
School of Medicine, Griffith University, Gold Coast, AUS.
Cureus. 2023 Mar 27;15(3):e36728. doi: 10.7759/cureus.36728. eCollection 2023 Mar.
The coronavirus disease 2019 (COVID-19) pandemic forced many changes. In our unit, there was a significant shift from traditional anesthesia (TA) which included general or regional anesthesia, to Wide-Awake Local Anesthesia No Tourniquet (WALANT) for the treatment of flexor tendon injuries. Zones I and II injuries have always been a challenge. The primary aim of this study is to compare the 12-week range of motion (ROM) flexor tendon repair outcomes between the TA group and wide-awake (WA) group patients. The secondary aim is to compare the complications and the follow-up rate between the two groups.
All patients who underwent a primary finger flexor tendon repair in zone I or II without tendon graft for closed avulsions or open lacerations between April 2020 and March 2021 were included in the study. Electronic medical records were reviewed to record demographics, follow-up, ROM outcomes and complications.
Forty-four patients with 49 injured fingers were in the WA group, and 24 patients with 37 injured fingers were in the TA group. A complete follow-up with 12-week ROM outcomes was available for 15 patients with 16 injured fingers in the WA group and nine patients with 13 injured fingers in the TA group. Excellent to good outcomes in the WA group were reported in 56% of the cases versus 31% in the TA group, although the difference was not statistically significant. There were similar complications in both groups, with an overall rupture rate of 11.6%, a tenolysis rate of 3.5% and a reoperation rate of 9.3%. Complete 12-week follow-up was completed by 41% of patients overall after taking tendon ruptures into account.
This is one of the first studies comparing zones I and II flexor tendon ROM outcomes between WA anesthesia and TA. Overall, there was a trend toward superior ROM outcomes in the WA group, with similar complication rates in both groups. The difference between ROM outcomes was not statistically significant and the small sample size undermined the strength of the study. To provide stronger evidence, better-designed prospective studies are suggested that would compare WA techniques with TA techniques.
2019年冠状病毒病（COVID-19）大流行迫使许多情况发生了变化。在我们科室，治疗屈指肌腱损伤时，从包括全身麻醉或区域麻醉的传统麻醉（TA）显著转向了清醒局麻无止血带（WALANT）麻醉。Ⅰ区和Ⅱ区损伤一直是个挑战。本研究的主要目的是比较TA组和清醒（WA）组患者屈指肌腱修复术后12周的活动范围（ROM）结果。次要目的是比较两组之间的并发症和随访率。
纳入2020年4月至2021年3月期间在Ⅰ区或Ⅱ区接受原发性手指屈指肌腱修复且未进行肌腱移植治疗闭合性撕脱伤或开放性裂伤的所有患者。查阅电子病历以记录人口统计学信息、随访情况、ROM结果和并发症。
WA组有44例患者，49根手指受伤；TA组有24例患者，37根手指受伤。WA组有15例患者、16根手指以及TA组有9例患者、13根手指获得了完整的12周ROM结果随访。WA组56%的病例报告结果为优至良，TA组为31%，尽管差异无统计学意义。两组并发症相似，总体断裂率为11.6%，肌腱松解率为3.5%，再次手术率为9.3%。考虑到肌腱断裂情况，总体上41%的患者完成了完整的12周随访。
这是首批比较WA麻醉和TA麻醉下Ⅰ区和Ⅱ区屈指肌腱ROM结果的研究之一。总体而言，WA组有ROM结果更优的趋势，两组并发症发生率相似。ROM结果的差异无统计学意义，且样本量小削弱了研究的力度。为提供更有力的证据，建议开展设计更完善的前瞻性研究，比较WA技术和TA技术。
