Wide-awake flexor tendon repair.

The wide-awake approach to hand surgery is performed with no sedation and no tourniquet. Only locally injected tumescent lidocaine and epinephrine are used for anesthesia and hemostasis. The confirmation that epinephrine hemostasis in the finger is safe1–5 has permitted the use of this technique, which has now become widespread in Canada. With exceptions that include hand surgery in small children, major trauma patients, and on those who are mentally challenged, more than 95 percent of all of the hand surgery in our center is now being performed with the wide-awake approach. With the possible exception of tendon transfers,6 none of our hand operations have benefitted more from the advent of the wide-awake approach than flexor tendon repair. This videoplus presentation focuses on important technical aspects of wide-awake flexor tendon repair. It includes details of a zone 1 flexor tendon repair in a 16-year-old, from the injection of the local anesthetic to the 1-year postoperative result (see Video,SupplementalDigitalContent1,http://links. lww.com/A657 ).