• JungJun Hong, Ho-Jung Kang, Jong-Ick Whang, Seung-Yong Sung, Sung-Hoon Kim, Sung-Chul Shin, Si-Nae Kim, and Ji-Sup Kim.
• From the Department of Orthopaedic Surgery, National Health Insurance Service, Ilsan Hospital; the Department of Orthopaedic Surgery, College of Medicine, Yonsei University; Hand and Microsurgery, Duson Hospital; the Department of Orthopaedic Surgery, Catholic-Kwandong University; and the Biostatistics Collaboration Unit, Yonsei University College of Medicine.
• Plast. Reconstr. Surg. 2020 Mar 1; 145 (3): 723-733.

BackgroundThe wide-awake approach enables surgeons to perform optimal tensioning of a transferred tendon intraoperatively. The authors hypothesized that the extensor indicis proprius-to-extensor pollicis longus tendon transfer using the wide-awake approach would yield better results than conventional surgery.MethodsA retrospective analysis was performed of the prospectively collected data of 29 consecutive patients who underwent extensor indicis proprius-to-extensor pollicis longus tendon transfer. Patients were treated with the wide-awake approach (group A, n = 11) and conventional surgery under general anesthesia (group B, n = 18). The groups were compared retrospectively for thumb interphalangeal and metacarpophalangeal joint motion, grip and pinch strength, specific extensor indicis proprius-to-extensor pollicis longus evaluation method (SEEM), and Disabilities of the Arm, Shoulder and Hand questionnaire score at 6 weeks and 2, 4, 6, and 12 months postoperatively.ResultsGroup A showed significantly better interphalangeal joint flexion and total arc of motion at 6 weeks and 2, 4, and 6 months, and significantly better metacarpophalangeal joint flexion and total arc of motion at all time points. Interphalangeal and metacarpophalangeal joint extension showed no difference at all time points. Group A showed significantly better specific extensor indicis proprius-to-extensor pollicis longus evaluation method scores at 2 and 4 months, and Disabilities of the Arm, Shoulder and Hand questionnaire scores at 4, 6, and 12 months. Grip and pinch strength showed no difference at all time points. The complication rate and duration until return to work were not different between groups.ConclusionCompared with the conventional approach, the wide-awake approach showed significantly better results in the thumb's range of motion and functional outcomes, especially in the early postoperative periods.Clinical Question/Level Of EvidenceTherapeutic, III.

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