Wide-awake flexor pollicis longus tendon reconstruction with evaluation of the active voluntary contraction of the ruptured muscle-tendon

Background: 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 (FPL) tendon with evaluation of the voluntary active contraction distance (ACD) of the ruptured musculotendinous unit. Methods: Eleven consecutive patients underwent tendon reconstruction under wide-awake surgery for chronic tendon rupture of the FPL. If the total of the passive distraction distance (PDD) and the ACD of the ruptured FPL musculotendinous unit was greater than 30 mm, tendon grafting was performed. If not, tendon transfer was performed using the 4th flexor digitorum superficialis (FDS). Patients were evaluated with total active motion (TAM) before surgery, during surgery, and in final follow-up and subjectively surveyed with quick Disability of the Arm, Shoulder, and Hand (q-DASH) scores. The final outcomes of tendon grafting and of tendon transfer were compared. Results: Tendon grafting was performed in 4 patients, and tendon transfer was performed in 7 patients while maintaining finger active motion during surgery. The final follow-up %TAM was 84.3%±12.7% in the tendon transfer group and 80.7%±10.2% in the tendon grafting group. There were no significant differences between tendon transfer and tendon grafting in the final follow-up %TAM and q-DASH scores. Conclusions: The functional outcomes of both tendon grafting and tendon transfer were acceptable based on evaluating the ACD and PDD of the ruptured musculotendinous unit during wide-awake surgery. Evaluating the ACD and PDD 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 TAM during surgery while adjusting suture tension. Financial Disclosure: none Acknowledgements: none This report was approved by the Ethics Comitee, University of Toyama (Toyama, Japan) and clinical reaserch number "21-22" was granted. Corresponding auther: Mineyuki Zukawa. MD ©2018American Society of Plastic Surgeons