Wide Awake Flexor Tendon Repair in the Finger

W ide awake flexor tendon repair means no tourniquet and no sedation tendon repair under pure local lidocaine and epinephrine finger and hand anesthesia. The 5 main advantages of doing the repair this way in the unsedated patient are as follows: (1) fewer postoperative ruptures happen because intraoperative testing of the tendon repair reveals gaps in 7% of cases that are repaired before skin closure.1 (2) These repairs get less tenolysis because intraoperative testing of the repair guides the surgeon to vent pulleys that impede full flexion or extension of the finger.2 (3) Surgeons educate the lucid patient during the surgery, so he understands how to avoid rupture and getting stuck.3 (4) Intraoperative flexor tendon repair testing guides the surgeon in the decision to maintain a superficialis repair or resect a superficialis slip.4 (5) Seeing full active flexion and extension with no gap during the surgery empowers the surgeon to allow up to half a fist of true active postoperative flexion (not place and hold) 3 to 5 days after surgery.5