Skip to main content
JDRS · Open access journal
Joint Diseases and
Related Surgery
Online manuscript submissionSubmit a manuscript e-ISSN 2687-4792

Original Article · Open access

The effect of WALANT on outcomes of flexor tenolysis

PDF Cite this article

Özgün Barış Güntürk

Department of Orthopedics and Traumatology, Division of Hand Surgery, EMOT Hospital, İzmir, Türkiye

ORCID: 0000-0003-4022-5821

Deniz Dikmen Meral

Hand Therapy Unit, EMOT Hospital, İzmir, Türkiye

ORCID: 0009-0000-0568-1958

Can Yener

Department of Orthopedics and Traumatology, Division of Hand Surgery, EMOT Hospital, İzmir, Türkiye

ORCID: 0000-0001-7925-6591

Kubilay Erol

Department of Orthopedics and Traumatology, Division of Hand Surgery, EMOT Hospital, İzmir, Türkiye

ORCID: 0000-0001-6759-6636

Anıl Koca

Department of Orthopedics and Traumatology, Division of Hand Surgery, EMOT Hospital, İzmir, Türkiye

ORCID: 0000-0001-9450-5859

Abstract

Objectives: This study aims to evaluate the outcomes of the flexor tenolysis cases with wide-awake local anesthesia no tourniquet (WALANT) and to compare them with cases with other anesthesia types.

Patients and methods: Between March 2004 and March 2024, a total of 104 patients with 150 fingers with flexor tenolysis (71 males, 33 females; mean age: 32.67 ± 11.64 years; range, 16 to 62 years) were included in the study. The WALANT group consisted of 41 patients with 53 fingers, while the conventional anesthesia group consisted of 63 patients with 97 fingers. Pre- and postoperative total active motion (TAM) gains were compared between the two groups and relevant factors were investigated.

Results: Overall TAM gain was 47% in our study cohort. The TAM gain was 55% and 43% in the WALANT group and in the conventional anesthesia group, indicating a statistically significant difference (p = 0.005). The best TAM gains were observed in the clean-cut injury type. The TAM gains were better in the cases without fractures. Age was a significant factor in the tenolysis outcomes, and younger patients had improved outcomes.

Conclusion: Our study results indicate a significant difference in the TAM gain between the WALANT and conventional methods. Taken together, we believe that the application of WALANT in tenolysis of flexor tendon adhesions represents a significant advancement in hand surgery. The ability to perform the procedure under local anesthesia while allowing for immediate assessment of tendon function enhances the surgical precision and results.

Declarations

Author Contributions

Ö.B.G., K.E.: Researched literature and conceived the study; D.D.M.: Was involved in protocol development; C.Y.: Involved in data analysis; Ö.B.G.: Wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved its final version.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

AI Disclosure

The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.

References

  1. Tang JB. Recent evolutions in flexor tendon repairs and rehabilitation. J Hand Surg Eur Vol 2018;43:469-73. DOI: 10.1177/1753193418773008.
  2. Civan O, Gürsoy MK, Cavit A, Özcanlı H, Karalezli MN. Tenolysis rate after zone 2 flexor tendon repairs. Jt Dis Relat Surg 2020;31:281-5. DOI: 10.5606/ehc.2020.71752.
  3. Demers AJ, Moran TE, Bustos FP, Forster GL, Natal E, DeGeorge BR Jr. Revision of flexor tendon repair: Factors associated with flexor tenolysis. Hand (N Y) 2024;19:664-70. DOI: 10.1177/15589447221142890.
  4. Rosenblum MK, Baltodano PA, Weinberg MH, Whipple LA, Gemmiti AL, Whipple RE. The fine wire technique for flexor tenolysis. Plast Reconstr Surg Glob Open 2017;5:e1557. DOI: 10.1097/GOX.0000000000001557.
  5. Kher S, Graham DJ, Symes M, Lawson R, Sivakumar BS. Outcomes of isolated digital flexor tenolysis: A systematic review. J Hand Surg Asian Pac Vol 2021;26:580-7. DOI: 10.1142/S2424835521500557.
  6. Van Carlen M, Plonczak A, Van J, Mishra A, Breahna AN. A systematic review of the outcomes of flexor tenolysis in zones 2-5. J Hand Surg Asian Pac Vol 2022;27:607-14. DOI: 10.1142/S2424835522500576.
  7. Grandizio L, Graham J, Klena J. Current trends in WALANT surgery: A survey of American Society for Surgery of the Hand members. J Hand Surg Glob Online 2020;2:186-90. DOI: 10.1016/j.jhsg.2020.04.011.
  8. Bamal R, Alnobani O, Bastouros E, Nolan G, Morris E, Griffiths S, et al. Wide-Awake Local Anesthesia No Tourniquet (WALANT) for flexor tendon repairs as change in practice during the cOVID-19 pandemic: A retrospective cohort study with outcomes. Cureus 2023;15:e36728. DOI: 10.7759/cureus.36728.
  9. Kang SW, Park HM, Park JK, Jeong HS, Cha JK, Go BS, et al. Open cubital and carpal tunnel release using wide-awake technique: Reduction of postoperative pain. J Pain Res 2019;12:2725-31. DOI: 10.2147/JPR.S210366.
  10. Tang JB. Wide-awake primary flexor tendon repair, tenolysis, and tendon transfer. Clin Orthop Surg 2015;7:275- 81. DOI: 10.4055/cios.2015.7.3.275.
  11. Lalonde DH. Conceptual origins, current practice, and views of wide awake hand surgery. J Hand Surg Eur Vol 2017;42:886-95. DOI: 10.1177/1753193417728427.
  12. Ayhan E, Tuna Z, Oksuz C. Getting better results in flexor tendon surgery and therapy. Plast Reconstr Surg Glob Open 2021;9:e3432. DOI: 10.1097/GOX.0000000000003432.
  13. Tang JB, Giddins G. Why and how to report surgeons' levels of expertise. J Hand Surg Eur Vol 2016;41:365-6. DOI: 10.1177/1753193416641590.
  14. Tang JB, Gong KT, Xing SG, Yi L, Xu JH. Wide-awake hand surgery in two centers in China: Experience in Nantong and Tianjin with 12,000 patients. Hand Clin 2019;35:7-12. DOI: 10.1016/j.hcl.2018.08.011.
  15. Ghoraba SM, Alsharkawy KG, Hammad M, Samak HA. Salvage of extensively scarred hands: Wide awake tenolysis and interpositional free tissue transfer. Plast Reconstr Surg Glob Open 2021;9:e3949. DOI: 10.1097/GOX.0000000000003949.
  16. Gonzalez-Torres C, Deliz-Jimenez D, Claudio-Marcano A, Donestevez-Antuñano J, Roura-Rovira R, Foy-Parrilla C. Middle finger tenolysis using WALANT surgical technique in a pediatric patient: A case report. Int J Surg Case Rep 2023;110:108746. DOI: 10.1016/j.ijscr.2023.108746.
  17. Kurtzman JS, Etcheson JI, Koehler SM. Wide-awake local anesthesia with no tourniquet: An updated review. Plast Reconstr Surg Glob Open 2021;9:e3507. DOI: 10.1097/GOX.0000000000003507.
  18. Breton A, Jager T, Dap F, Dautel G. Effectiveness of flexor tenolysis in zone II: A retrospective series of 40 patients at 3 months postoperatively. Chir Main 2015;34:126-33. DOI: 10.1016/j.main.2015.04.002.