Wide awake hand surgery

Advantages of “wide awake” hand surgery help both the patient and the hand surgeon.

Surgery has been performed under local anaesthetic for many years, but recently the indications in hand surgery have exploded.  Now many of the patients that undergo surgery by consultant hand surgeon Mike Hayton for are suitable for this method.

Mike perfected this technique from Don Lalonde a hand surgeon from Canada.Mike first saw the method demonstrated by Don when they were both the invited guest speakers at the American Association for Hand Surgery in 2011. 

Since then they have become good friends and are both often joint faculty at the leading North American conferences.

The benefits are pretty obvious to his patients with no immediate post operative pain, no post operative grogginess or nausea and an earlier discharge from the hospital that may occur with a general anaesthetic.

But there are also significant advantages for the surgeon and Mike puts this down to the fact that wide awake surgery is more dynamic and he can interact in real time with his patient and the tissue on which he is operating.

A few examples

Finger joint replacement



The implants can be inserted and tested for range of movement immediately on the table with the patient wide awake, if too stifthen more bone can be resected until the movement is perfect.

Tendon repair and transfer



Tendons that are repaired or transferred are assessed for correct tensioning and gliding immediately at the time of repair with the patient being asked to actively move their own hand. Any problems can be identified, rectified and re checked.

Release of catching structures

Operations to remove catching tissues such as bone, tendons or ligaments can be performed with enhanced results, as the feedback is immediate and in real time.  

For example, if after removing some offending bone the catching continues, Mike can take away a little more until the structures run free and the problem solved.

Such “active” fine-tuning would not be possible with a patient under general anaesthetic without the dynamic feedback from the wide-awake patient.

It’s a bit like a wide awake “surgical test drive”

Mike sometimes looks on the advantages of wide-awake surgery a bit like a new car “test drive”. He gets to see the results of his surgery immediately and can micro adjust at the time.

Whilst the majority of patients are suitable for “wide awake” hand surgery  some are not suitable and this would be discussed pre operatively in the out patient clinic.