Skip to main content
SpringerLink
Log in

Flexor digitorum superficialis tendon transfer to extensor pollicis longus in the absence of palmaris longus tendon: a wide-awake anaesthesia approach

  • Original Paper
  • Published:
European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

The absence of the palmaris longus tendon poses a challenge in cases of long-standing radial nerve palsy. This study aims to evaluate the outcomes of using the flexor digitorum superficialis (FDS) tendon of the ring finger for transfer to the extensor pollicis longus (EPL) tendon under wide-awake local anesthesia with no tourniquet (WALANT).

Methods

A retrospective review of 12 patients with unrecovered radial nerve palsy who underwent FDS transfer to EPL, pronator teres to extensor carpi radialis brevis, and flexor carpi radialis transfer to the extensor digitorum communis under WALANT between 2019 and 2023 was conducted. Functional outcomes were assessed using a modified Bincaz score.

Results

The mean age of the patients was 42 years (range 28–55). All patients achieved a good score in functional outcomes. The mean Visual Analog Scale (VAS) score was 0.75 (range, 0–2). Most patients experienced immediate postoperative comfort, with only two reporting mild pain during the radial periosteum injection. Notably, none of the patients required additional analgesics or sedation during the procedure. All patients exhibited successful thumb extension, finger extension, and wrist dorsiflexion, indicating the adaptability of brain plasticity to tendon transfer and the feasibility of WALANT. Age, gender, side, and treatment delay did not significantly impact functional outcomes.

Conclusions

The FDS ring finger transfer to EPL in the absence of the palmaris longus tendon proves to be an effective surgical approach, yielding favorable outcomes. Wide-awake anesthesia with no tourniquet offers advantages such as intraoperative tension adjustment and enables patient participation in rehabilitation, thereby enhancing surgeon confidence for initiating early rehabilitation.

Level of Evidence:

Level IV, therapeutic study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

The data is available with the due consent of the patients.

References

  1. Sebastin SJ, Puhaindran ME, Lim AY, Lim IJ, Bee WH (2005) The prevalence of absence of the palmaris longus–a study in a Chinese population and a review of the literature. J Hand Surg Br. ;30(5):525-7. https://doi.org/10.1016/j.jhsb.2005.05.003. PMID: 16006020

  2. Lim AY, Lahiri A, Pereira BP, Kumar VP, Tan LL (2004) Independent function in a split flexor carpi radialis transfer. J Hand Surg Am. ;29(1):28–31. doi: 10.1016/j.jhsa.2003.09.011. PMID: 14751099

  3. Gousheh J, Arasteh E (2006) Transfer of a single flexor carpi ulnaris tendon for treatment of radial nerve palsy. J Hand Surg Br. ;31(5):542-6. https://doi.org/10.1016/j.jhsb.2006.05.003. Epub 2006 Jul 11. PMID: 16814906

  4. Al-Qattan MM (2012) Tendon transfer for radial nerve palsy: a single tendon to restore finger extension as well as thumb extension/radial abduction. J Hand Surg Eur Vol 37(9):855–862 Epub 2012 Feb 6. PMID: 22311919

    Article  CAS  PubMed  Google Scholar 

  5. Chuinard RG, Boyes JH, Stark HH, Ashworth CR (1978) Tendon transfers for radial nerve palsy: use of superficialis tendons for digital extension. J Hand Surg Am. ;3(6):560 – 70. https://doi.org/10.1016/s0363-5023(78)80007-0. PMID: 214482

  6. Boyes JH (1960) Tendon transfers for radial palsy. Bull Hosp Joint Dis 21:97

    Google Scholar 

  7. Krishnan KG, Schackert G (2008) An analysis of results after selective tendon transfers through the interosseous membrane to provide selective finger and thumb extension in chronic irreparable radial nerve lesions. J Hand Surg Am. ;33(2):223 – 31. https://doi.org/10.1016/j.jhsa.2007.10.015. PMID: 18294545

  8. Jerome JTJ (2023) Wide-awake local anesthesia no tourniquet and dexamethasone (WALANT-D) for modified Camitz opponens plasty in severe carpal tunnel syndrome-a retrospective study of 30 cases. J Clin Orthop Trauma 43:102228. https://doi.org/10.1016/j.jcot.2023.102228PMID: 37547272; PMCID: PMC10403721

    Article  PubMed  Google Scholar 

  9. Jerome JTJ (2023) Wide-awake local anesthesia no tourniquet (WALANT) for reconstruction of flexor pollicis longus ruptures following volar plate fixation of distal radius fractures- A Case series. J Orthop Rep 2(3):100162. https://doi.org/10.1016/j.jorep.2023.100162

    Article  Google Scholar 

  10. Jerome J, Terrence Jose (2022) Introduction. Clinical examination of the Hand: an evidence-based Approach. Ed. J. Terrence Jose Jerome, 1st edn. CRC, p 24

  11. Bincaz LE, Cherifi H, Alnot JY (2002) Les transferts palliatifs de réanimation de l’extension du poignet et des doigts. A propos de 14 transferts pour paralysie radiale et dix transferts pour lésion plexique [Palliative tendon transfer for reanimation of the wrist and finger extension lag. Report of 14 transfers for radial nerve palsies and ten transfers for brachial plexus lesions]. Chir Main. ;21(1):13–22. French. https://doi.org/10.1016/s1297-3203(01)00081-6. PMID: 11885382

  12. Cheah AE, Etcheson J, Yao J (2016) Radial Nerve Tendon Transfers. Hand Clin. ;32(3):323 – 38. https://doi.org/10.1016/j.hcl.2016.03.003. PMID: 27387076

  13. Agarwal P, Kukrele R, Sharma D (2020 Jul-Aug) Outcome of tendon transfer for radial nerve palsy using Flexor Carpi Radialis combination (brands transfer). J Clin Orthop Trauma 11(4):630–636. https://doi.org/10.1016/j.jcot.2020.05.012Epub 2020 May 18. PMID: 32684701; PMCID: PMC7355057

  14. Jones NF, Machado GR (2011) Tendon transfers for radial, median, and ulnar nerve injuries: current surgical techniques. Clin Plast Surg. ;38(4):621 – 42. https://doi.org/10.1016/j.cps.2011.07.002. PMID: 22032590

  15. Hentz VR (2019) Tendon transfers after peripheral nerve injuries: my preferred techniques. J Hand Surg Eur Vol. ;44(8):775–784. doi: 10.1177/1753193419864838. Epub 2019 Jul 31. PMID: 31364477

  16. Tordjman D, d’Utruy A, Bauer B, Bellemère P, Pierrart J, Masmejean E (2022) Tendon transfer surgery for radial nerve palsy. Hand Surg Rehabil 41S:S90–S97. https://doi.org/10.1016/j.hansur.2018.09.009Epub 2021 Jul 31. PMID: 34343724

    Article  CAS  PubMed  Google Scholar 

  17. Abdullah S, Ahmad AA, Lalonde D (2020) Wide Awake Local Anesthesia No Tourniquet Forearm Triple Tendon transfer in Radial nerve Palsy. Plast Reconstr Surg Glob Open 8(8):e3023. https://doi.org/10.1097/GOX.0000000000003023PMID: 32983779; PMCID: PMC7489616

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Olympia Hospital & Research Centre, 47, 47A Puthur High Road, Puthur, Trichy, Tamilnadu, India

    J. Terrence Jose Jerome & Dharani Karunanithi

Authors
  1. J. Terrence Jose Jerome
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dharani Karunanithi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

J Terrence Jose Jerome: Roles/writing – original draft, Data curation, Conceptualization.

Corresponding authors

Correspondence to J. Terrence Jose Jerome or Dharani Karunanithi.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval granted by the Ethical Committed Board of OHRC (No 07/2024).

Informed consent

The patients and/or their families were informed that data from the research would be submitted for publication, and they consented.

Conflict of interest

No conflicts of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Registration of Research Studies: 1. Name of the registry: Not applicable. 2. Unique Identifying number or registration ID: Not applicable. 3. Hyperlink to your specific registration (must be publicly accessible and will be checked): Not applicable.

Guarantor: J Terrence Jose Jerome

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jerome, J.T.J., Karunanithi, D. Flexor digitorum superficialis tendon transfer to extensor pollicis longus in the absence of palmaris longus tendon: a wide-awake anaesthesia approach. Eur J Plast Surg 47, 44 (2024). https://doi.org/10.1007/s00238-024-02194-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00238-024-02194-1

Keywords

Search

Navigation