Name of the Procedure:

Opponensplasty; tendon transfer with graft (includes obtaining graft)
Common name: Opponensplasty

Summary

Opponensplasty is a surgical procedure that involves transferring a tendon, often with a graft, to restore thumb opposition – the ability to touch the thumb to the fingers. The graft is taken from another part of the body and used to improve function of a damaged or weakened thumb muscle.

Purpose

This procedure addresses thumb weakness or paralysis, often due to conditions like congenital deformity, nerve injury, or degenerative diseases. The goal is to restore the thumb's range of motion and improve hand function, allowing patients to grasp and manipulate objects more effectively.

Indications

• Thumb weakness or paralysis
• Congenital thumb deformities
• Nerve injuries (e.g., median nerve palsy)
• Degenerative conditions affecting thumb muscles
• Inadequate thumb function despite conservative treatments

Preparation

• Fasting may be required if general anesthesia is used.
• Adjustment of medications, especially blood thinners.
• Preoperative imaging or nerve conduction studies to assess the extent of the problem.
• Physical examination to evaluate hand and thumb function.

Procedure Description

1. Anesthesia: Administered either locally, regionally, or generally, depending on the case.
2. Incision: A surgical cut is made to access the donor tendon and recipient site.
3. Harvesting Graft: A suitable tendon graft is harvested from another part of the body (commonly from the forearm or leg).
4. Tendon Transfer: The donor tendon is transferred and sutured to the thumb muscles to facilitate opposition.
5. Graft Placement: The harvested graft is placed and secured to enhance tendon strength and movement.
6. Closure: The incision site is closed with sutures and dressed.

Duration

The procedure typically takes 1-2 hours depending on complexity.

Setting

Performed in a hospital operating room or surgical center.

Personnel

• Orthopedic or hand surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurse
• Surgical technician

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Graft failure
• Scarring
• Persistent weakness or limited range of motion
• Need for additional surgeries

Benefits

• Improved thumb function and hand dexterity
• Enhanced ability to grip and manipulate objects
• Increased independence in daily activities
• Benefits typically realized within weeks to months as healing progresses

Recovery

• Immobilization of the hand initially with a cast or splint
• Physical therapy to restore strength and range of motion
• Pain management with medications
• Follow-up appointments for wound care and progress monitoring
• Full recovery may take several months

Alternatives

• Non-surgical treatments (e.g., splinting, physical therapy)
• Other surgical procedures (e.g., different tendon transfer techniques)
• Pros: Non-invasive options have lower risk; cons: may not be as effective or may not restore full function.

Patient Experience

During the procedure, you will not feel pain due to anesthesia; you may feel drowsy or sedated. After the procedure, expect some pain and swelling, managed with medication. Full recovery involves commitment to physical therapy and regular follow-up visits to ensure proper healing and function restoration.