Acta Scientific Orthopaedics (ISSN: 2581-8635)

Case Report Volume 6 Issue 6

Repair of Flexor Tendons of the Hand by WALANT Method

Víctor Caricabel Marín1, Vladimir Andrés Vásquez Encalada2, Reynier E Pacheco Sánchez1, Jessael Ramirez Batecas2 and Alberto Pichs Borges3

1Doctor of Medicine, First Degree Specialist in Orthopedics and Traumatology, Calixto García General University Hospital
2Doctor of Medicine, Third Year Resident in Orthopedics and Traumatology, Calixto García General University Hospital
3Doctor of Medicine, Second Year Resident in Orthopedics and Traumatology, Calixto García General University Hospital

*Corresponding Author: Víctor Caricabel Marín, Doctor of Medicine, First Degree Specialist in Orthopedics and Traumatology, Calixto García General University Hospital.

Received: April 19, 2023; Published: May 18, 2023


Introduction: Hand injuries involving flexor tendons associated with neurovascular damage should be considered an orthopedic emergency in all trauma centers.

Objectives: To evaluate the benefits of the WALANT Method in the repair surgery of flexor tendons of the hand, in patients operated in the Orthopedics and Traumatology service of the Calixto García University Hospital, in the period from June to December 2021. Method: An observational, descriptive, prospective and cross-sectional study was conducted in 25 patients with traumatic flexor tendon injuries, operated by the WALANT Method, by Basic Work Groups 2 and 3 using as variables age, sex, pain during infiltration and transoperative, associated injuries, complications and hospital stay.

Results: 100% of patients presented pain during infiltration rated on the VAS scale of mild (0-3), while in the transoperative period all had a pain of 0. Transoperative bleeding in 80% of patients was less than 10 ml. Of the total number of patients, only five had associated neurovascular lesions. The hospital stay in most patients was less than 12 hours.

Conclusions: The WALANT method is a safe and reliable therapeutic alternative for hand flexor tendon repair surgery, significantly reducing anesthetic complications, transoperative bleeding and hospital stay.

Keywords:WALANT; Flexor Tendons; Local Anesthesia


  1. Healthy diet. World Health Organization (2004).
  2. Controlling the global obesity epidemic. World Health Organization (2004).
  3. Global Strategy on Diet, Physical Activity and Health. (Resolution WHA55.23 of Member States at World Health Assembly. “World Health Organization (2004).
  4. Feng Q., et al. “Raw and Cooked Vegetable Consumption and Risk of Cardiovascular Disease: A Study of 400,000 Adults in UK Biobank”. Frontiers in Nutrition 9 (2022): 831470.
  5. Alissa EM and Ferns GA. “Dietary fruits and vegetables and cardiovascular diseases risk”. Critical Reviews in Food Science and Nutrition 9 (2017): 1950-1962.
  6. Aune D., et al. “Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality-a systematic review and dose-response meta-analysis of prospective studies”. International Journal of Epidemiology 3 (2017): 1029-1056.
  7. Mellendick K., et al. “Diets Rich in Fruits and Vegetables Are Associated with Lower Cardiovascular Disease Risk in Adolescents”. Nutrients2 (2018): 136.
  8. Zurbau A., et al. “Relation of Different Fruit and Vegetable Sources With Incident Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies”. Journal of the American Heart Association 19 (2020): e017728.
  9. D Hu., et al. “Fruits and Vegetables Consumption and Risk of Stroke: A Meta-Analysis of Prospective Cohort Studies”. Stroke (2014).
  10. Lin CL. “Stroke and diets - A review”. Tzu Chi Medical Journal3 (2021): 238-242.
  11. He FJ., et al. “Fruit and vegetable consumption and stroke: meta-analysis of cohort studies”. Lancet (London, England)9507 (2006): 320-326.
  12. Halvorsen RE., et al. “Fruit and vegetable consumption and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of prospective studies”. BMJ Nutrition, Prevention and Health (2020):
  13. Barouti AA., et al. “Fruit and vegetable intake and risk of prediabetes and type 2 diabetes: results from a 20-year long prospective cohort study in Swedish men and women”. European Journal of Nutrition 61 (2022): 3175-3187.
  14. PY Wang., et al. “Higher intake of fruits, vegetables or their fiber reduces the risk of type 2 diabetes: a meta-analysis”. Journal of Diabetes Investigation 1 (2016): 56-69.
  15. Tuck NJ., et al. “Assessing the effects of vegetable consumption on the psychological health of healthy adults: A systematic review of prospective research”. The American Journal of Clinical Nutrition 110 (2019): 196-211.
  16. Simone Radavelli-Bagatini., et al. “Fruit and vegetable intake is inversely associated with perceived stress across the adult lifespan”. Clinical Nutrition5 (2021): 2860.
  17. Głąbska D., et al. “Fruit and Vegetable Intake and Mental Health in Adults: A Systematic Review”. Nutrients1 (2020): 115.
  18. Saghafian F., et al. “Fruit and vegetable consumption and risk of depression: accumulative evidence from an updated systematic review and meta-analysis of epidemiological studies”. British Journal of Nutrition 10 (2018): 1087-1101.
  19. Canella DS., et al. “Consumption of vegetables and their relation with ultra-processed foods in Brazil”. Revista de Saúde Pública 52 (2018):
  20. Ministério da Saúde (BR), Secretaria de Vigilância em Saúde, Departamento de Vigilância de Doenças e Agravos não Transmissíveis e Promoção da Saúde. Vigitel Brasil 2014: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília (DF) (2015).
  21. Instituto Brasileiro de Geografia e Estatística. “Pesquisa Nacional de Saúde do Escolar 2012”. Rio de Janeiro: IBGE (2013).
  22. Despot-Lucanin J., et al. “Relationship of different measures of self-reported health in a follow-up study of older persons”. Psychological Studies 47 (2005): 145-156.
  23. Stanojevic Jerkovic O., et al. “Determinants of self-rated health in elderly populations in urban areas of Slovenia, Lithuania and UK: findings of the EURO-URHIS 2 survey”. European Journal of Public Health 2 (2017): 74-79.
  24. Elżbieta Antczak and Katarzyna M Miszczyńska. “The self-perceived high level of health quality of Europeans - spatial analysis of determinants”. Journal of Applied Economics1 (2017): 746-764.
  25. Bombak AE. “Self-rated health and public health: A critical perspective”. Frontiers in Public Health 1 (2013): 15.
  26. Freidoony L., et al. “The components of self-perceived health in the Kailali district of Nepal: A cross-sectional survey”. International Journal of Environmental Research and Public Health3 (2015): 3215-3323.
  27. De Salvo KB., et al. “Mortality prediction with a single general self-rated health question. A meta-analysis”. Journal of General Internal Medicine 21 (2006): 267-275.
  28. Ocampo JM. “Self-rated health: importance of use in elderly adults”. Colombia Médica 41 (2010): 275-289.
  29. Kananen L., et al. “Self-rated health in individuals with and without disease is associated with multiple biomarkers representing multiple biological domains”. Scientific Reports11 (2021): 6139.
  30. Vingård E., et al. “Chapter 9. consequences of being on sick leave”. Scandinavian Journal of Public Health 32 (2004): 207-215.
  31. Miilunpalo S., et al. “Self-Rated health status as a health measure: the predictive value of self-reported health status on the use of physician services and on mortality in the working-age population”. Journal of Clinical Epidemiology 50 (1997): 517-528.
  32. Kaplan G., et al. “Subjective state of health and survival in elderly adults”. Journal of Gerontology 43.4 (1988): S114-S120.
  33. Lee Y. “The predictive value of self assessed general, physical, and mental health on functional decline and mortality in older adults”. Journal of Epidemiology and Community Health 54 (2000): 123-129.
  34. Chodzko-Zajko WJ., et al. “Exercise and physical activity for older adults”. Medicine and Science in Sports and Exercise 41 (2009): 1510-1530.
  35. Lera-Lopez F., et al. “How the relationship between physical activity and health changes with age”. European Journal of Ageing 16 (2019): 3-15.
  36. Heiestad H., et al. “., et al. “Investigating self-perceived health and quality of life: a longitudinal prospective study among beginner recreational exercisers in a fitness club setting”. BMJ Open 10 (2020):
  37. Kretschmer AC and Loch MR. “Association between eating behaviors and positive self-perception of health in Brazilian Adults”. Archivos Latinoamericanos de Nutrición2 (2022): 84-92.
  38. Guan M. “Associations of fruit and vegetable intake and physical activity with poor self-rated health among Chinese older adults”. BMC Geriatrics 1 (2022): 10.
  39. Meireles AL., et al. “Self-rated health in urban adults, perceptions of the physical and social environment, and reported comorbidities: The BH Health Study. Cad”. Saúde Pública 1 (2015): 120-135.
  40. Câmara SG and Strelhow M. “Self-Perceived Health among School-Aged Adolescents: a School-Based Study in Southern Brazil”. Applied Research in Quality of Life 3 (2019): 603-615.
  41. Ferrari Geraldo Jose., et al. “Socioenvironmental factors and behaviors associated with negative self-rated health in Brazil”. Ciência and Saúde Coletiva09 (2023): 4309-4320.
  42. Lucas Akio Trindade and Flavia Sarti. “Factors Associated with Regular Consumption of In Natura Foods and Soft Drinks, and Their Influence on Self-Rated Health Among Brazilian Adults”. Current Developments in Nutrition1 (2022): 404.
  43. Departamento de Análise em Saúde e Vigilância de Doenças Não Transmissíveis, Secretaria de Vigilância em Saúde, Ministério da Saúde. Vigitel Brasil 2019: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: “Estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2019”. Brasília: Ministério da Saúde (2020).
  44. Santin F., et al. “Food consumption markers and associated factors in Brazil: distribution and evolution, Brazilian National Health Survey, 2013 and 2019”. Saúde Pública 38.1 (2022): e00118821.
  45. Pesquisa nacional de saúde 2019: informações sobre domicílios, acesso e utilização dos serviços de saúde. Brasil, grandes regiões e unidades da federação/IBGE, Coordenação de Trabalho e Rendimento. - Rio de Janeiro, IBGE (2020).
  46. World Health Organization SN. Health interview surveys: Towards international harmonization of methods and instruments. Copenhagen: WHO Office for Europe (1996).
  47. Taft C., et al. “Do SF-36 summary component scores accurately summarize subscale scores?” Quality of Life Research 10 (2001): 395-404.
  48. Ware JE and Kosinski M. “Interpreting SF-36 summary health measures: a response”. Quality of Life Research 10 (2001): 405-413, 415-420.
  49. Strand Steve., et al.Module 5 - Ordinal Regression: Key Assumptions of Ordinal Regression. Re Store”. National Centre for Research Methods (NCRM).
  50. Allison PD. “Logistic Regression Using the SAS System: Theory and Application, Cary, NC: SAS Institute Inc (1999).
  51. Richard Williams. "Ordinal regression models: Problems, solutions, and problems with the solutions," German Stata Users' Group Meetings 2008 03, Stata Users Group (2008).
  52. Richard Williams. “Using the margins command to estimate and interpret adjusted predictions and marginal effects”. The Stata Journal2 (2012): 308-331.
  53. J Scott Long and Jeremy Freese. “Regression Models for Categorical Dependent Variables Using Stata, Third Edition. College Station, TX: Stata Press (2014).
  54. Richard Williams. “Adjusted Predictions and Marginal Effects for Multiple Outcome Models and Commands (including ologit, mlogit, oglm, and gologit2). University of Notre Dame (2021).
  55. Williams R. “Generalized ordered logit/partial proportional odds models for ordinal dependent variables”. The Stata Journal1 (2022): 58-82.
  56. Lu N., et al. “Dietary behavior in relation to socioeconomic characteristics and self-perceived health status”. Journal of Health Care for the Poor and Underserved 2 (2002): 241-257.
  57. Ministério da Saúde (BR), Secretaria de Atenção à Saúde, Departamento de Atenção Básica. Guia alimentar para a população brasileira. 2nd. edition. Brasília (DF) (2014).
  58. Jofe M and Robertson A. “The potential contribution of increased vegetable and fruit consumption to health gain in the European Union”. Public Health Nutrition 4 (2021): 893-901.
  59. Michels KB., et al. “Fruit and vegetable consumption and colorectal adenomas in the nurses’ health study”. Cancer Research 7 (2006): 3942-3953.
  60. Myint PK., et al. “Fruit and vegetable consumption and self-reported functional health in men and women in the European prospective investigation into Cancer-Norfolk (EPIC-Norfolk): a population-based cross-sectional study”. Public Health Nutrition 1 (2007): 34-41.
  61. Araújo J., et al. “Lifestyles and self-rated health, in Portuguese elderly from rural and urban areas”. Acta Médica Portuguesa 2 (2011): 79-88.
  62. Sorensen MD., et al. Women’s health initiative writing group. “Dietary intake of fiber, fruit and vegetables decreases the risk of incident kidney stones in women: a Women’s Health Initiative report”. Journal of Urology6 (2014): 1694-1699.
  63. Hrezova E., et al. “Low fruit and vegetable intake is associated with poor self-rated health in the Czech part of the HAPIEE study”. Nutrition and Health (2021).
  64. Loch MR and Possamai CL. “Associação entre percepção de saúde e comportamentos relacionados à saúde em adolescentes escolares de Florianópolis, SC”. Ciências de Cuidado à Saúde2 (2007): 377-383.
  65. Wu S., et al. “The relationship between self-rated health and objective health status: a population-based study”. BMC Public Health 13 (2013): 320.
  66. Schatzkin A., et al. “A comparison of a food frequency questionnaire with a 24-hour recall for use in an epidemiological cohort study: results from the biomarker-based Observing Protein and Energy Nutrition (OPEN) study”. International Journal of Epidemiology 6 (2003): 1054-1062.
  67. Timon CM., et al. “A review of the design and validation of web- and computer-based 24-h dietary recall tools”. Nutrition Research Reviews 2 (2016): 268-280.


Citation: Víctor Caricabel Marín., et al. “Repair of Flexor Tendons of the Hand by WALANT Method”.Acta Scientific Orthopaedics 6.6 (2023): 44-48.


Copyright: © 2023 Víctor Caricabel Marín., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Acceptance rate33%
Acceptance to publication20-30 days

Indexed In

News and Events

  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is May 30, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US