Patients Kept Awake While Plastic Surgeons Operate

Patients are released from doctors' care sooner and recover better if kept awake during hand surgery and given only local anesthesia, say physicians at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2007 conference in Baltimore. The innovative technique, in which plastic surgeons can make adjustments during surgery, may reduce the need for revisions, complications with general anesthesia, expense, and recovery time.


"Patients with fractures, carpal tunnel syndrome and other common hand problems can have reconstructive plastic surgery while they are able to move and provide real-time feedback," said Donald Lalonde, MD, ASPS Member Surgeon and course presenter. "The ability to speak and move an appendage contradicts one's mental image of surgery. However, having the patient awake and coherent provides better outcomes and they are amazed the procedure is pain free."


With this technique, no tourniquet is used, so patients can perform a full range of motion with their fingers, allowing the surgeon to make any necessary adjustments on reconstructed tendons and bones before the skin is closed. The wide-awake approach has the potential to decrease the need for revision surgery in tendon transfers and tendon repairs.


When compared to traditional hand surgery techniques, the wide-awake approach has been shown to reduce costs by 25 percent and cut down on operating times without compromising patient safety. The procedure is performed under local anesthesia, so patients avoid common complications of general anesthesia such as nausea and vomiting.


Physical therapy is often painful for those who have undergone hand surgery and patients can easily become discouraged, impeding their progress. With the wide-awake approach, physical therapists show the patients movements that help with rehabilitation during surgery and patients can see how much movement they will regain while they are pain free.


Common hand surgeries performed with the wide-awake approach include trigger finger release, tendon, nerve, carpal tunnel, and fracture repair. Nearly 156,000 reconstructive hand surgeries were performed in 2006, according to ASPS statistics.


While the wide-awake approach offers a surgical advance in hand surgery, it is important to discuss anesthesia options with an ASPS Member Surgeon as this technique may not be appropriate for all patients or hand injuries.


Visit plasticsurgery for referrals to ASPS Member Surgeons and to learn more about cosmetic and reconstructive plastic surgery.


The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 6,000 members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises 90 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.


The course "The Wide Awake Approach to Hand Surgery" was presented Monday, Oct. 29, 12:00 p.m. to 1:00 p.m., at the Baltimore Convention Center, Baltimore.

American Society of Plastic Surgeons