WALANT Surgery for Fracture FixationAugust 28, 2020
ReplantationSeptember 18, 2020
Wide Awake Local Anaesthetic No Tourniquet hand surgery is a technique that enables safe, effective and pain-free hand surgery for almost all hand surgical indications.
During the Covid-19 crisis this has been particularly useful as it reduces both staff and patient viral exposure risk, by obviating the requirement for the anaesthetic team and reducing operating room staff numbers. Patients benefit from there being no general anaesthetic risks associated with their surgery. Note in these photographs the reduced blood flow to the surgical field as the skin ‘blanches’ white around the injured area.
WALANT techniques in tendon surgery enable reduced incisions for tendon retrieval as the
patient can ‘actively’ relax the injured tendon by contracting the corresponding tendons on the
other side of the hand. This inevitably causes the injured tendon to migrate to the site of its
division, reducing the requirement for extending exploratory incisions into the hand.
There are additional technical benefits for the patient and surgeon. Surgical efficacy can be
checked and demonstrated in real-time between the patient and the surgeon. In this video the
patient is able to demonstrate a full range of movement of their hand, the glide of the repaired
tendon can be seen with no catching on pulleys, and good strength showing no gapping in the
The surgeon and patient can discuss during the case together the required rehabilitation
protocol that must be adhered to following the procedure. The patient can ask any questions they
have about their case and answers can be given with demonstration of the exercises that must be
I am grateful to this patient for consenting to allow their images to be shared. They made a
full recovery and returned to work within 2 months of their surgery.