Name of the Procedure:

Opponensplasty; other methods. Common name(s): Opponensplasty

Summary

Opponensplasty is a surgical procedure aimed at improving hand function by restoring the thumb's ability to oppose (move towards) the fingers. This is typically achieved by transferring a tendon from another part of the body to the thumb.

Purpose

Opponensplasty is performed to address thumb dysfunction, particularly in cases where the thumb can no longer oppose the fingers due to nerve injury, muscular atrophy, or congenital conditions. The primary goal is to enhance grip and pinch strength, thereby improving the hand's overall functionality.

Indications

• Inability to oppose the thumb due to median nerve paralysis.
• Traumatic injuries causing tendon damage.
• Congenital conditions affecting thumb opposition.
• Progressive muscular atrophy affecting hand function.

Preparation

• Patients may be required to undergo blood tests and imaging studies (like X-rays or MRI) to assess the extent of the damage.
• Fasting may be required for a certain period before the surgery.
• Adjustments to medications, particularly blood thinners, as advised by the physician.
• Pre-surgical clearance from a primary care physician or specialist, if necessary.

Procedure Description

1. Anesthesia: The patient is administered regional anesthesia or general anesthesia, depending on the case.
2. Incision: A surgical incision is made to access the tendon to be transferred.
3. Tendon Transfer: A tendon, typically from a nearby muscle like the palmaris longus or extensor indicis, is harvested.
4. Reattachment: The harvested tendon is then attached to the thumb's base, ensuring it can facilitate opposition.
5. Closure: The incisions are closed with sutures, and the area is dressed.
6. Splinting: The thumb and hand are usually splinted to ensure proper healing.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Opponensplasty is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic or hand surgeon
• Surgical nurses
• Anesthesiologist
• Physical therapist (post-surgery)

Risks and Complications

• Infection at the surgical site.
• Nerve damage leading to numbness or weakness.
• Tendon rupture or failure to integrate properly.
• Scar formation and reduced range of motion.
• Prolonged pain or swelling.

Benefits

• Improved thumb opposition and hand function.
• Enhanced ability to perform daily activities requiring grip and pinch strength.
• Potential improvement in quality of life.

Recovery

• Post-procedure care includes wound dressing changes and monitoring for signs of infection.
• The hand is usually immobilized in a splint for several weeks.
• Physical therapy is essential for regaining strength and flexibility.
• Full recovery can take from several weeks to a few months, depending on individual healing rates.

Alternatives

• Nonsurgical treatments like physical therapy, orthotic devices, and occupational therapy.
• Other surgical options such as nerve grafting, depending on the underlying cause.
• Each alternative varies in invasiveness, recovery time, and overall effectiveness.

Patient Experience

• Patients may experience discomfort or pain post-surgery, managed with prescribed pain medications.
• Initial limitations in hand movements due to splinting, followed by gradual improvement with physical therapy.
• Close follow-up care to monitor healing and hand function progress.