Name of the Procedure:

Opponensplasty; superficialis tendon transfer type

Summary

Opponensplasty is a surgical procedure that involves transferring a tendon from another part of the hand to restore thumb opposition (the ability to touch the thumb to the fingertips). The superficialis tendon transfer type uses the flexor digitorum superficialis tendon from one of the fingers. This procedure helps improve hand function, particularly in patients who have lost thumb opposition due to nerve damage or muscle weakness.

Purpose

Opponensplasty addresses the loss of thumb opposition, which can significantly impair hand function. The goal is to improve the hand's ability to grasp, pinch, and perform fine motor tasks by providing the thumb with the necessary movement and strength.

Indications

• Loss of thumb opposition due to nerve injuries, such as median nerve palsy
• Congenital defects affecting thumb movement
• Muscle or tendon damage resulting in weakened thumb opposition
• Conditions like cerebral palsy or spinal cord injuries affecting hand function

Patient criteria:

• Sufficient tendon function in the donor finger
• Overall good health to undergo surgery
• Functional requirements necessitate restored thumb opposition

Preparation

• Pre-operative evaluation including a physical examination and assessment of hand function.
• Imaging studies like X-rays or MRI may be needed to plan the procedure.
• Patients may need fasting for a specified period before surgery.
• Temporary adjustments to medications, such as blood thinners.
• Discussion of anesthesia options with the anesthesiologist.

Procedure Description

1. The patient is administered general or local anesthesia.
2. A surgical incision is made to access the flexor digitorum superficialis tendon.
3. The tendon is carefully separated and released from its original attachment.
4. The surgeon then routes the tendon to the thumb muscle requiring reinforcement.
5. The tendon is anchored to the thumb's phalanx or surrounding structures using sutures or anchors.
6. The incision is closed with sutures, and a bandage or cast is applied to protect the hand.

Duration

The procedure typically lasts between 1 to 2 hours.

Setting

Opponensplasty is usually performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic or plastic surgeon specialized in hand surgery
• Surgical nurses
• Anesthesiologist or nurse anesthetist
• Surgical technologists

Risks and Complications

• Infection
• Bleeding or hematoma formation
• Scarring or unsatisfactory cosmetic result
• Nerve damage or weakness
• Stiffness or reduced range of motion in the hand or donor finger
• Failure of the tendon transfer to restore function

Benefits

• Improved thumb opposition and hand function
• Enhanced ability to perform daily tasks and activities
• Increased overall quality of life
• Benefits may be observed within weeks, with full recovery and function improvement over several months

Recovery

• Post-procedure immobilization of the hand in a splint or cast for several weeks
• Physical therapy to regain strength and flexibility
• Regular follow-up appointments to monitor healing
• Gradual resumption of normal activities; full recovery may take several months
• Pain management with prescribed medications

Alternatives

• Non-surgical options like physical therapy and orthotic devices
• Other types of opponensplasty (e.g., using different tendons)
• Nerve grafting or muscle transfers in severe cases

Pros and Cons:

• Non-surgical treatments are less invasive but may be less effective.
• Alternative surgical techniques might offer different benefits or suit different patient needs.

Patient Experience

During the procedure:

• Anesthesia will prevent pain and discomfort.
• The patient may feel some pressure or movement.

After the procedure:

• Initial soreness, swelling, and bruising are common.
• Pain management with prescribed medications.
• Physical therapy to aid in the recovery of hand function.

Patients should follow all postoperative instructions and attend follow-up visits for the best outcomes.