Brain Plasticity after Tendon Transfer under Local Anesthesia

Abstract

Sixty-four patients with functional disabilities of the upper extremities underwent wide-awake tendon transfer between 2003 and 2015. Forty-one patients were male, and the average patient age was 55 years (range: 17-84 years). Under local anesthesia (lidocaine with epinephrine), all transferred tendons were routed subcutaneously and woven into the recipient tendons. Restored hand function was confirmed in all patients before skin closure. During the operations, 59 patients who underwent tendon transfers using synergists (e.g. the extensor carpi radialis longus to the flexor digitorum profundus) or proximity donors (e.g. the extensor indicis proprius to the extensor pollicis longus), were immediately able to use the reconstructed hand without delay. The remaining five patients who underwent the brachioradialis transfer to the flexor pollicis longus, the palmaris longus transfer to the flexor pollicis longus, or the extensor digiti minimi transfer to the extensor pollicis longus were unable to perform thumb flexion or extension during surgery, but they all exhibited the full range of thumb motion at the final evaluation. We consider tendon transfer to be unaccompanied by immediate functional switching during surgery, but as it was later found to be successful, it may reflect brain plasticity.