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

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 stiff then 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


To make an appointment please call Fiona 0845 838 7766

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