Impacts of the COVID-19 pandemic on hand surgery outpatient clinic application trends and patient attitude towards surgical procedures

The Use of the S-MART Tourniquet in Hand Surgery: A Safe and Effective Way to Provide a Bloodless Field

Surgery Research and Practice ◽

10.1155/2014/402184 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3

Author(s):

O. Templeton-Ward ◽

J. Feher ◽

P. Davey

Keyword(s):

Postoperative Complications ◽

Surgical Procedures ◽

Hand Surgery ◽

Bloodless Field

We have retrospectively reviewed our use of the S-MART sterile silicon ring self-exsanguinating tourniquet in 300 consecutive minor hand surgical procedures. A total of 3 postoperative complications were identified, only 1 of which was directly related to the tourniquet’s use. We outline the reasons of why we feel that this device provides a safe and effective bloodless field and the benefits of its use.

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Surgical treatment of relapsed megaesophagus

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-6991e-20202444 ◽

2020 ◽

Vol 47 ◽

Author(s):

LUIGI CARLO DA SILVA COSTA ◽

JOÃO GABRIEL ROMERO BRAGA ◽

VALDIR TERCIOTI JUNIOR ◽

JOÃO DE SOUZA COELHO NETO ◽

JOSÉ ANTÔNIO POSSATTO FERRER ◽

...

Keyword(s):

Weight Loss ◽

Retrospective Study ◽

Surgical Treatment ◽

Postoperative Complications ◽

Chagas Disease ◽

Surgical Procedures ◽

Postoperative Period ◽

Outpatient Clinic ◽

Surgical Result ◽

Stage 1

ABSTRACT Objective: to analyze the surgical treatment of patients with recurrent megaesophagus followed at the esophageal-stomach-duodenal outpatient clinic of the Hospital de Clínicas - UNICAMP. Methods: a retrospective study, from 2011 to 2017, with 26 patients with Chagas or idiopathic megaesophagus, surgically treated, and who recurred with dysphagia. Clinical, endoscopic and radiographic aspects were assessed and correlated with the performed surgical procedures. Results: 50% had dysphagia for liquids, 69% regurgitation, 65.3% heartburn, 69.2% weight loss and 69.2% had Chagas disease. In addition, 38.4% had megaesophagus stage 1 and 2 and 61.5% stage 3 and 4. Regarding the reoperations, 53% of them underwent Heller-Pinotti surgery by laparoscopy, Serra-Dória in 30.7% and esophageal mucosectomy in 7.9%. In 72% of the reoperations there were no postoperative complications, and 80% of the patients had a good outcome, with reduction or elimination of dysphagia. Among the reoperated patients undergoing the laparoscopic Heller-Pinotti technique, three reported little improvement of dysphagia in the postoperative period and among those who underwent Serra-Dória surgery, 100% had no dysphagia. It was observed that, when the time between the first procedure and the reoperation was longer, the better the surgical result was, with statistical significant decreased dysphagia (p=0.0013, p<0.05). Conclusions: there was a preference to perform laparoscopic re-miotomy and, as a second option, Serra-Dória surgery, for patients with recurrent megaesophagus. Esophagectomy or esophageal mucosectomy were reserved for more severe patients.

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Wide awake local anesthesia no tourniquet (WALANT) – a revolutionary improvement in hand surgery

British Journal of Surgery ◽

10.1093/bjs/znab202.055 ◽

2021 ◽

Vol 108 (Supplement_4) ◽

Author(s):

M Cardell ◽

F Jung ◽

N Zechmann-Müller ◽

M Greminger ◽

L Kern ◽

...

Keyword(s):

Local Anesthesia ◽

Surgical Procedures ◽

Flexor Tendon ◽

Hand Surgery ◽

Patient Comfort ◽

Injection Pain ◽

Tendon Transfers ◽

Fracture Stabilization ◽

Wide Awake ◽

No Tourniquet

Abstract Objective Wide awake local anesthesia no tourniquet (WALANT) hand surgery offers the opportunity to create a bloodless field without using an arm tourniquet. Lidocaine for anesthesia mixed with epinephrine for hemostasis is frequently used without concerns in the hand and finger. This is a major improvement for the patient and the surgeon in terms of patient comfort and having the opportunity to test the hand and finger function intraoperatively. The movement away from tourniquet surgery, which often requires sedation or general anaesthesia is one of the most significant recent advances in hand surgery. Methods A subcutaneous infiltration of a mixture (1:100’000) of lidocaine (1%) and epinephrine (buffered 10:1 with 8.4% bicarbonate) is done with a 27 G canula. The mixture is infiltrated wherever surgical dissection, k-wire insertion, or manipulation of fractured bones will occur. The local anesthetic results in an extravascular Bier block. The injection is done slowly from proximal to distal to minimize injection pain. After the last injection a minimum time of 30 minutes should be waited for maximal epinephrine vasoconstriction in the finger. Results In the beginning WALANT was only used for small procedures like trigger finger or carpal tunnel release. Meanwhile also major hand surgical procedures like finger fractures, flexor tendon repairs, tendon transfers, arthroscopies, arthroplasties and open triangular fibrocartilage complex (TFCC) repair are performed in WALANT. Even procedures like trapeziectomy have been described using wide awake hand surgery, which involves numbing the joint itself. Conclusion The use of WALANT is a proven safe technique that can be used in up to 95% of hand surgical procedures. The benefits for patients and surgeons are obvious. Patients prefer the technique because there are no side effects of opiates or sedation. The anesthetic risk is minimized. Time at hospital is reduced. Patients do not have to suffer tourniquet pain. Surgeons prefer the technique because of the bloodless surgical field without tourniquet, the possibility of intraoperative testing of stability of prosthesis or fracture stabilization, strength of a tendon repair, the movement and gliding properties in the flexor tendon sheath after repair or testing the tension of tendon transfers. These are probably the reasons for the continuously growing popularity of this technique worldwide.

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The efficacy of WALANT technique in Hand Surgery

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i9.37773 ◽

2021 ◽

Vol 12 (9) ◽

pp. 136-141

Author(s):

Niraj Ranjeet ◽

Pratyenta Raj Onta ◽

Krishna Sapkota ◽

Pabin Thapa ◽

Upendra jung Thapa ◽

...

Keyword(s):

Surgical Procedures ◽

Hand Surgery ◽

Dental Procedure ◽

Duration Of Surgery ◽

Level 3 ◽

The Mean ◽

Procedural Components ◽

Wide Awake ◽

No Tourniquet ◽

Better Than

Background: Nowadays, Wide Awake Local Anesthesia No Tourniquet (WALANT) technique has gained popularity among surgeons because of its use in variety of surgical procedures because it provides excellent hemostasis, eliminating the need of tourniquet, sedation and the risk and cost of general anesthesia. Aims and Objective: In this study, we wanted to evaluate its efficacy and the experiences of the patients and surgeons in different hand surgeries. Materials and Methods: We had 108 patients who underwent various hand surgeries under WALANT technique. Patients and surgeons were requested to fill a questionnaire after the procedure. The procedure was evaluated in terms of the pain compared to a dental procedure, duration of the anesthesia, amount of bleeding and patients’ satisfaction. Results: The mean age of our patients was 42.7 years. A variety of hand surgery was performed in our study. The mean local anaesthetic volume used was 16.5 ml. The Tang grading system was used to evaluate the levels of surgeon’s experience; 75% of surgeons were a Level 2, 18% Level 3 and 7% Level 4. Sixty-four patients experienced WALANT to be less than, 30 patients equivalent to and 8 had more pain compared to a dental procedure. There was a significant correlation between volume of local anesthetic used, duration of surgery and number of procedural components repaired. Both pain and anxiety levels were significantly less intra-operatively and postoperatively as compared to the level at the time of injection. Eighty-seven patients considered it to be better than expected, and would prefer it in the future in case they have to undergo surgery. Conclusion: We observed that our patients were satisfied with their experience on WALANT technique and the surgical procedures, and we recommend the use of this for a variety of hand surgery procedures.

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Timed wake-up anaesthesia in hand: A modification to wide awake surgery of hand

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.197221 ◽

2016 ◽

Vol 49 (03) ◽

pp. 378-383 ◽

Cited By ~ 1

Author(s):

Jagannath Kamath ◽

Trivikram Shenoy ◽

Nikil Jayasheelan ◽

Naufal Rizwan ◽

Vartika Sachan ◽

...

Keyword(s):

Surgical Procedures ◽

Full Range ◽

Hand Surgery ◽

Awake Surgery ◽

Modified Technique ◽

Upper Arm ◽

Modified Method ◽

Hand Wash ◽

Wide Awake ◽

Fine Tune

ABSTRACT Introduction: Wide awake surgery of the hand (WASH) is a well-accepted technique in hand surgery which allows the surgeon to identify and rectify on the table of some of the inadvertent shortcomings in the surgical procedures to optimise the final outcome. The advantage, however, precludes the use of tourniquet. We describe a modified method which preserves all the advantages of WASH and allows the surgeon to use tourniquet. Patients and Methods: Thirty-one cases of hand surgeries were carried out using the modified technique where a wrist block was supplemented with the ultra-short acting intravenous propofol which allowed the surgeon to use the upper arm tourniquet. The propofol infusion was stopped, and the tourniquet was released after the important surgical step. Within an average of 10 min of stoppage of the infusion, all the patients were awake for active intraoperative painless movements to aid the surgeon to identify, rectify and fine tune the procedure to optimise the results. Results: Five of the 31 patients needed correction based on the intraoperative movements. All the 31 patients were pain free at the surgical site during surgery. All the 31 patients were cooperative enough to perform full range of pain-free intraoperative movements. No patient experienced significant tourniquet pain during the procedure. Patient’s and surgeon’s satisfaction at the end of the procedure has been quite satisfactory. Conclusion: Timed wake-up anaesthesia, an improvement over the original WASH, has been suggested where the surgeon can add without subtracting the benefits of the procedure in the form of usage of the tourniquet providing the clear tissue plane and haemostasis during the surgery. However, an additional cost is incurred for the use of anaesthesia and equipment should be kept in mind.

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The funding of private hospitals in Australia

Australian Health Review ◽

10.1071/ah020019 ◽

2002 ◽

Vol 25 (1) ◽

pp. 19 ◽

Cited By ~ 5

Author(s):

Abby L. Bloom

Keyword(s):

Surgical Procedures ◽

Private Hospital ◽

Capital Expenditure ◽

Hand Surgery ◽

Private Hospitals ◽

Public And Private ◽

Alcohol Disorders ◽

Revenue Sources ◽

Health Funding ◽

Comprehensive Picture

Private hospitals are an essential component of Australia's complex mix of public and private health funding and provision. Private hospitals account for 34.3 per cent of all hospital separations, and over half (56.2%) of all same-dayseparations. The revenue (funding) of the sector approached $4 billion by 1998/99, and as a result of its recent rapid growth capital expenditure in the sector was nearly $550 million in the same year. Private casemix of privatehospitals is distinctive, and characterised by a high proportion of surgical procedures in general (48.1per cent), andmore than a majority of all services in such areas as rehabilitation, orthopaedics (shoulder, knee, spinal fusion, and hand surgery), alcohol disorders, same day colonoscopy and sleep disorders. This chapter synthesises data from amultitude of sources to produce a comprehensive picture of Australia's private hospital sector and its funding. It examines the funding (revenue) sources of private hospitals, and considers how and why private hospitals approach theissue of funding from a different perspective than their public sector colleagues. To illustrate how Australian privatehospitals approach revenue (funding) strategically, a series of indicative types of hospitals is explored.

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Solo Hand Surgery

Canadian Journal of Plastic Surgery ◽

10.1177/229255030501300306 ◽

2005 ◽

Vol 13 (3) ◽

pp. 145-147 ◽

Cited By ~ 3

Author(s):

Michael Sg Bell ◽

Bert J Reitsma

Keyword(s):

Local Anesthesia ◽

Outpatient Clinic ◽

Cost Savings ◽

Hand Surgery ◽

Surgical Instruments ◽

Hospital Resource ◽

Significant Cost ◽

New Era ◽

Surgical Assistants ◽

New Instruments

Unassisted hand surgery is being undertaken by necessity for both elective and emergency cases, due to hospital resource restrictions. The authors outline the principles of local anesthesia, surgeon-controlled tourniquet techniques, and a number of new instruments which allow a surgeon to work in comfort and safety, unassisted. The traditional surgical instruments designed for the days when trained surgical assistants were available to hold them are no longer suitable. We are entering a new era of surgical design with safer instruments that can complement our skills rather than challenge them. There are significant cost savings and efficiency when hand procedures are undertaken in the emergency and outpatient clinic settings.

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Patients’ perspective of wide-awake hand surgery — 100 consecutive cases

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193412475241 ◽

2013 ◽

Vol 38 (9) ◽

pp. 992-999 ◽

Cited By ~ 35

Author(s):

I. Teo ◽

W. Lam ◽

P. Muthayya ◽

K. Steele ◽

S. Alexander ◽

...

Keyword(s):

Surgical Procedures ◽

Tendon Transfer ◽

Hand Surgery ◽

Postal Questionnaire ◽

Awake Surgery ◽

General Anaesthetic ◽

Satisfaction Level ◽

High Satisfaction ◽

Wide Awake ◽

Patients Perspective

The wide-awake hand surgery (WAHS) technique involves injecting lidocaine with adrenaline for hand surgical procedures that are done without the use of tourniquets, sedation, regional or general anaesthetic. This is a retrospective review of the first 100 consecutive patients who underwent operations using this technique at our centre. The operations included carpal and cubital tunnel decompression, trapeziectomy, tendon transfer, and tenolysis. A questionnaire adapted from Lalonde’s previous work on wide-awake surgery was used to assess patients’ experiences. Sixty-five percent of the patients responded to the postal questionnaire, the majority reporting a high satisfaction level. Ninety-one percent of responders reported that the operation was less painful or comparable with a procedure at the dentist; 86% would prefer to be wide-awake if they needed to have hand surgery again, and 90% stated they would recommend WAHS to a friend.

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