Carreño Ana, Cequier Laia Sabate, Trepat Anna Domingo, Carnicero Nuria, Barreda Daniel Martín
Department of Orthopaedics and Trauma Surgery, Hospital Clinic Barcelona, University of Barcelona, Spain.
Independent Hand Therapist and Researcher, Barcelona, Spain.
J Hand Microsurg. 2024 Oct 24;17(2):100170. doi: 10.1016/j.jham.2024.100170. eCollection 2025 Mar.
Flexor tendon pulley reconstruction in patients with multiple pulley ruptures and proximal interphalangeal joint contracture after closed injuries is relatively uncommon. The paucity of evidence in the literature supporting one technique can make these surgical decisions and surgeries challenging. This article presents the surgical technique we use for treatment of the proximal interphalangeal joint stiffness and pulley reconstruction at the same time, using wide-awake local anesthesia with no tourniquet (WALANT). The clear advantage of this anesthetic technique for this procedure is the ability to directly verify the contracture release and tendon's gliding through the reconstructed pulley system during the patient's active mobilization, allowing the surgeon to make adjustments during the surgery and educating the patient on the postoperative therapy.
闭合性损伤后出现多个滑车破裂和近端指间关节挛缩的患者进行屈肌腱滑车重建相对少见。文献中支持某一种技术的证据不足，这使得这些手术决策和手术颇具挑战性。本文介绍了我们同时治疗近端指间关节僵硬和滑车重建所采用的手术技术，即使用无止血带的清醒局部麻醉（WALANT）。这种麻醉技术用于该手术的明显优势在于，在患者主动活动时能够直接确认挛缩松解情况以及肌腱在重建滑车系统中的滑动情况，使外科医生能够在手术过程中进行调整，并指导患者术后治疗。
