Peru: OR Surgeon Blog

Source: Blog Post

We had a team of attendings, a fellow, residents, and medical students complete 45 surgeries during the week, including everything from trigger finger releases to polydactyly release and web-space deepening to index pollicization procedures. The local hospital staff was also very inviting and supportive to both our team and the patients. Spending time with our patients and their families was one of the most memorable parts of our time in Peru. Their lives and experiences served as a touching and poignant reminder of our organization’s mission and purpose, something that would be impossible without the encouragement and support of Touching Hands and the American Society for Surgery of the Hand (ASSH). One notable case was a tendon transfer for an 8-year-old boy. A case presentation can be found below.

An 8-Year-old Peruvian boy presented for consultation to the Instituto Nacional de Salud del Niño with a two-year history of inability to extend his fingers on his right hand. The patient had a remote history of radial nerve injury at the mid-humeral level rendering his extensor muscle group non-functional. This injury significantly affected his quality of life, rendering his right hand useless to perform activities of daily living or skilled labor.

Shown in the picture is the patient preoperatively. Notice his inability to extend his fingers or wrist.

Given the timeline since the injury, we planned a tendon transfer to restore extension of his digits and thumb. The tendons identified for transfer were the palmaris longus and flexor carpi radialis, which would be inserted into the tendons for extensor pollicis longus and extensor digitorum communis, respectively.

The following picture demonstrates the identification of the palmaris longus tendon.

The following image is the identification of the extensor carpi radialis.

Following harvest of the tendon, a subcutaneous tunnel was formed from the volar to dorsal portion of the forearm around the distal radius.

Transfer of the PL to the dorsum of the wrist.

This is the identification of the EPL tendon.

Identification of EDC.

The start of the weave.

Following, hemostasis was achieved, and the incisions were closed.

Compared with the pre-operative image, the post-operative image demonstrates the patient already has achieved some level of passive extension. This will improve as the patient works with the hand therapist to regain active extension.