gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Extending application of wide-awake surgery: flap harvest and transfer in the hand in 39 patients

Meeting Abstract

Suche in Medline nach

  • presenting/speaker Shuguo Xing - Affiliated Hospital of Nantong University, Nantong, China
  • Tian Mao - Affiliated Hospital of Nantong University, Nantong, China
  • Guheng Wang - Affiliated Hospital of Nantong University, Nantong, China
  • Jinbo Tang - Affiliated Hospital of Nantong University, Nantong, China

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-48

doi: 10.3205/19ifssh0660, urn:nbn:de:0183-19ifssh06605

Veröffentlicht: 6. Februar 2020

© 2020 Xing et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives/Interrogation: It is advised that wide-awake surgery under local anesthetic with epinephrine (WALANT) should not be used for flap surgery. We used WALANT in harvesting flaps in 39 patients. We report our experience of using WALANT in the flap harvest and transfer in the hand.

Methods: From April 2017 to May 2018, we used local anesthetic with epinephrine injection to the hands of 39 patients (18 to 67 years old, 23 man, 16 women) in performing 10 extended Segmuller flaps, 6 homodigital reverse digital artery flaps and 23 Atasoy flaps. The anesthetic with epinephrine was injected to proximal, middle and distal parts of the finger along volar midline before flap harvest. We evaluated intra-operative pain levels, easiness of flap harvest, and observed pulsation of the digital arteries during surgery. We also assessed postoperative flap survival and patient satisfaction.

Results and Conclusions: During the operation, no patients required the use of a temporary tourniquet, and our technique achieved adequate bleeding control. We observed normal pulsation of the digital arteries in all 16 digital artery pedicle flaps. No procedures required termination because of pain. All patients had successful transfer of the flaps with good blood perfusion to the flap 4-5 hours after surgery. All flaps survived completely, except that one extended Segmuller flap had a 3 mm wide strip of skin necrosis, likely caused by tight skin closure, which healed after simple debridement. The patients are satisfied with this approach and stated that they would choose this approach if they had the flap surgery in the hand again.

Our patient series showed that flap surgery in the hand can be performed under WALANT. The digital artery pulsates normally after epinephrine injection. We found digital artery pulsation is not affected by local epinephrine injection and injection of epinephrine does not cause flap failure. The one flap with narrow skin necrosis in one patient was due to tight skin suture, which appears unrelated to the epinephrine injection. WALANT is safe and provides excellent anesthetic in our cases in flap harvesting and transfer in the hand.