Rotura espontánea del tendón extensor largo del pulgar – transferencia tendínea con técnica anestésica WALANT

Resumen

La rotura espontanea del tendón extensor largo del pulgar (ELP), es una patología infrecuente existiendo casos reportados en la literatura donde no se logra encontrar factores predisponentes. El manejo quirúrgico suele realizarse utilizando una técnica de transposición tendínea del tendón del extensor propio del índice. En la actualidad, la técnica anestésica de WALANT “Wide Awake Local Anesthesia with No-Torniquet” ha sido de amplio desarrollo en la cirugía de la mano, sobre todo para la resolución quirúrgica de patología de tendones, con buenos y excelentes resultados. Se presenta un caso de un paciente con rotura espontánea del tendón ELP, que fue manejado con una transferencia tendínea utilizando la técnica anestésica WALANT.

Abstract

The spontaneous rupture of thumb extensor pollicis longus (EPL) is a rare disease with just a few case reports known where no trigger factor has been found. The surgical management is done by the proper index extensor tendon transposition. Nowadays, the WALANT anesthetic technique (“Wide Awake Local Anesthesia with No-Torniquet”) has had a broad development in hand surgery, especially in surgery for tendon injuries, with good and excellent results. A clinical case is shown with a patient who had a spontaneous EPL rupture which was managed with a tendon transfer under the WALANT anesthetics technique.

Palabras Clave

cirugía de la mano - ELP - extensor largo del pulgar - transferencias tendíneas - WALANT

Keywords

hand surgery - EPL - extensor pollicis longus ruptura - tendon transfer - WALANT

Responsabilidades Éticas

Protección de personas y animales. Los autores declaran que para esta investigación no se han realizado experimentos en seres humanos ni en animales.

Confidencialidad de los datos. Los autores declaran que han secundado los protocolos de su centro de trabajo sobre la publicación de los datos de los pacientes.

Derecho a la privacidad y consentimiento informado. Los autores han obtenido el consentimiento informado de los pacientes y/o sujetos referidos en el artículo. Este documento obra en poder del autor de correspondencia.

• Referencias

• 1 Cigna E, Özkan Ö, Mardini S, Chiang PT, Yang CH, Chen HC. Late spontaneous rupture of the extensor pollicis longus tendon after corticosteroid injection for flexor tenosynovitis. Eur Rev Med Pharmacol Sci 2013; 17 (06) 845-848
• 2 Kim CH. Spontaneous rupture of the extensor pollicis longus tendon. Arch Plast Surg 2012; 39 (06) 680-682
• 3 Rada EM, Shridharani SM, Lifchez SD. Spontaneous atraumatic extensor pollicis longus rupture in the nonrheumatoid population. Eplasty 2013; 13: e11
• 4 Hu C-H, Fufa D, Hsu C-C, Lin Y-T, Lin C-H. Revisiting spontaneous rupture of the extensor pollicis longus tendon: eight cases without identifiable predisposing factor. Hand (NY) 2015; 10 (04) 726-731
• 5 Jain A, Goyal N, Mishra P. Spontaneous rupture of EPL and ECRB tendons in a washerwoman: an unusual phenomenon. Hand Surg 2014; 19 (02) 241-244
• 6 Shifflett GD, Ek ET, Weiland AJ. Spontaneous rupture of the extensor pollicis longus in a break-dancer. Eplasty 2014; 14: e4
• 7 Navaratnam AV, Ball S, Eckersley R. Prophylactic decompression of extensor pollicis longus to prevent rupture. BMJ Case Rep 2013; 2013 (13) bcr2013010196
• 8 Diep GK, Adams JE. The Prodrome of Extensor Pollicis Longus Tendonitis and Rupture: Rupture May Be Preventable. Orthopedics 2016; 39 (05) 318-322
• 9 Lalonde DH. Reconstruction of the hand with wide awake surgery. Clin Plast Surg 2011; 38 (04) 761-769
• 10 Davison PG, Cobb T, Lalonde DH. The patient's perspective on carpal tunnel surgery related to the type of anesthesia: a prospective cohort study. Hand (NY) 2013; 8 (01) 47-53
• 11 Farhangkhoee H, Lalonde J, Lalonde DH. Wide-awake trapeziectomy: video detailing local anesthetic injection and surgery. Hand (NY) 2011; 6 (04) 466-467
• 12 Higgins A, Lalonde DH, Bell M, McKee D, Lalonde JF. Avoiding flexor tendon repair rupture with intraoperative total active movement examination. Plast Reconstr Surg 2010; 126 (03) 941-945
• 13 Lalonde DH. Wide-awake extensor indicis proprius to extensor pollicis longus tendon transfer. J Hand Surg Am 2014; 39 (11) 2297-2299
• 14 Choi JC, Kim WS, Na HY. , et al. Spontaneous rupture of the extensor pollicis longus tendon in a tailor. Clin Orthop Surg 2011; 3 (02) 167-169
• 15 Engkvist O, Lundborg G. Rupture of the extensor pollicis longus tendon after fracture of the lower end of the radius--a clinical and microangiographic study. Hand 1979; 11 (01) 76-86
• 16 O'Sullivan MB, Singh H, Wolf JM. Tendon Transfers in the Rheumatoid Hand for Reconstruction. Hand Clin 2016; 32 (03) 407-416
• 17 Lalonde D, Eaton C, Amadio P, Jupiter J. Wide-awake Hand and Wrist Surgery: A New Horizon in Outpatient Surgery. Instr Course Lect 2015; 64: 249-259
• 18 Tang JB. Wide-Awake Primary Flexor Tendon Repair, Tenolysis, and Tendon Transfer. Clin Orthop Surg 2015; 7 (03) 275-281
• 19 Nodwell T, Lalonde D. How long does it take phentolamine to reverse adrenaline-induced vasoconstriction in the finger and hand? A prospective, randomized, blinded study: The Dalhousie project experimental phase. Can J Plast Surg 2003; 11 (04) 187-190
• 20 Chowdhry S, Seidenstricker L, Cooney DS, Hazani R, Wilhelmi BJ. Do not use epinephrine in digital blocks: myth or truth? Part II. A retrospective review of 1111 cases. Plast Reconstr Surg 2010; 126 (06) 2031-2034