It has been a great honour to be invited, for the second year running, as a contributing editor for the Yearbook of Hand and Upper limb surgery.
The four papers that I have asked been asked to review were interesting and provides significant advancements in our understanding of hand and wrist surgery.
The use of adrenaline with local anaesthetic injections without a tourniquet has been one of my most successful developments over the last 2 years. I agree with the authors of a publication that I commented upon in that waiting for 30 minutes or more increases the effect of adrenaline and providing a better bloodless field.
Operating without a tourniquet whilst the patient is wide awake using local anaesthetic has obvious added advantages for the patient including positive real-time dynamic feedback that may not be received should the patient be under general anaesthetic.
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