Glossary Investigation
iTAMe
Also known as intraoperative total active movement examination intraoperative active testing
iTAMe is the intraoperative quality-control test that wide-awake anaesthesia makes
possible for flexor tendon repair. With the patient awake and the digit unanaesthetised
proximally, the surgeon asks the patient to actively flex through the repair before
closure. A construct that tolerates active flexion without gapping is one that the
surgeon has empirical confidence will tolerate the same forces during early active
mobilisation; a construct that gaps is identified and re-repaired before the wound closes.
In the original Higgins series of 122 tendons in 102 patients, intraoperative gapping was
detected in 7 tendons and corrected; the overall rupture rate of 3.3% in that series was
attributable to postoperative protocol non-adherence rather than to construct failure.
iTAMe has since become the conceptual centrepiece of the WALANT-for-tendon-repair argument.