Notice bibliographique
Résumé
Wide 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 LOCAL ANESTHESIA Inject lidocaine with epinephrine (buffered 10:1 with 8.4% bicarbonate) everywhere you plan to dissect. Inject slowly from proximal to distal to decrease injection pain (See Video 1, Supplemental Digital Content 1, which displays a preoperative patient and local anesthetic injection. This video is available in the “Related Videos” section of the full-text article on PRSGlobalOpen.com or at https://links.lww.com/PRSGO/A212). Wait 30 minutes or more after the last injection to give time for maximal epinephrine vasoconstriction in the finger. OPERATIVE TIPS See Videos 2 to 4, Supplemental Digital Content 2, which demonstrates dissecting the skin flaps and exposing the sheath. This video is available in the “Related Videos” section of the full-text article on PRSGlobalOpen.com or at https://links.lww.com/PRSGO/A213). See video, Supplemental Digital Content 3, which demonstrates how to retrieve tendon ends. This video is available in the “Related Videos” section of the full-text article on PRSGlobalOpen.com or at https://links.lww.com/PRSGO/A214). See video, Supplemental Digital Content 4, which demonstrates how to suture the tendon and intraoperative patient education. This video is available in the “Related Videos” section of the full-text article on PRSGlobalOpen.com or at https://links.lww.com/PRSGO/A215). Repeatedly, test full active patient flexion and extension of the finger after each core and epitenon suture to make sure that there is no gap and that the repair fits through the pulleys. Repair any gaps and vent pulleys as required to get a full range of motion before skin closure. This is like testing blood flow in a vascular anastomosis to ensure function before skin closure. Have the patients extend the finger if you feel them pull against you as you retrieve the tendon. Extension generates reflex relaxation of flexor muscles. You do not need cautery. Bleeding stops by the time you sew back the skin flaps to expose the sheath. Surgeons can repair tendons in minor procedure rooms outside the main operating room in daytime hours. Involve hand therapists in patient teaching during surgery. POSTOPERATIVE THERAPY See Video 5, Supplemental Digital Content 5, which displays post operative therapy. This video is available in the “Related Videos” section of the full-text article on PRSGlobalOpen.com or at https://links.lww.com/PRSGO/A216.Video Graphic 1.: Preoperative patient and local anesthetic injection. See video, Supplemental Digital Content 1, which shows details of how to inject local anesthesia for wide awake flexor tendon repair. This video is available in the “Related Videos” section of the full-text article on PRSGlobalOpen.com or at https://links.lww.com/PRSGO/A212.Video Graphic 2.: Dissecting the skin flaps and exposing the sheath. See video, Supplemental Digital Content 2, which shows the dissection of skin flaps and exposure of the sheath of the patient introduced in Video 1. This video is available in the “Related Videos” section of the full-text article on PRSGlobalOpen.com or at https://links.lww.com/PRSGO/A213.Video Graphic 3.: Retrieving the tendon ends. See video, Supplemental Digital Content 3, which demonstrates how the surgeon gets the patient to extend the finger to relax the flexor tendon and let it come distally in the sheath by pushing it with Adson forceps through sheathotomies. This video is available in the “Related Videos” section of the full-text article on PRSGlobalOpen.com or at https://links.lww.com/PRSGO/A214.Video Graphic 4.: Suture the tendon and intraoperative patient education. See video, Supplemental Digital Content 4, which observes the step by step suturing of the tendon through sheathotomies, venting of the A4 pulley, intraoperative testing of the repair, and patient education during the surgery. This video is available in the “Related Videos” section of the full-text article on PRSGlobalOpen.com or at https://links.lww.com/PRSGO/A215.Video Graphic 5.: Postoperative therapy. See video, Supplemental Digital Content 5, which displays the postoperative therapy, demonstrating early protected true active flexion and extension (as opposed to place and hold) and final result with patient of Videos 1 and 2. This video is available in the “Related Videos” section of the full-text article on PRSGlobalOpen.com or at https://links.lww.com/PRSGO/A216. Immobilize and elevate the hand until swelling, friction, and work of flexion is gone (3–5 days). Initiate up to half a fist of true active movement (not place and hold).
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,020 | 0,005 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».