Player is loading...
A-0719 Wide Awake Hand Surgery - Limits and Complications
Kai Megerle, Julia Jakobus, Ursula Kraneburg, Hans-Gunther Machens, Clinic for Plastic Surgery and Hand Surgery, Technical University of Munich, Munich, Germany
Thursday, June 14, 2018 · 8:36 a.m. · 06m 59s
Embed
Embed code is not allowed
This talk is part of a Private webcast, embeding is not permited.Transcriptions
Note: this content has been automatically generated.
00:00:00
technique and i wanna share with you our experiences for the last
00:00:04
over the last couple of years with this really excellent technique
00:00:08
as you can see here um we have used it for a large number
00:00:12
of indications including both acute trauma cases
00:00:15
and also classic collective hand surgery
00:00:19
and uh energy that five year period i've operated on more than three hundred
00:00:24
patients slightly more men than women and ask easier
00:00:27
this to classic cheeks that's the young a
00:00:32
freshly injured patients and that it that that classic uh uh elective hand surgical collective
00:00:39
um we tried to a phone all the patient three reached almost two
00:00:44
hundred fifty patient contact telephone interviews and be obviously analyst or
00:00:49
yeah a patient's records regarding the infrared perceptive complications and we found
00:00:55
something that i wanna share with the right now so
00:00:57
some patients as he gestured i just not suitable for local anaesthesia and channel this doesn't
00:01:03
really it's not really specific to wide awake surgery but a local anaesthesia in general
00:01:08
and in our experience you should not try to persuade patients to go into this procedures
00:01:13
because the that it will be not a good experience for them and then it
00:01:17
will be a good experience for you either of so some of them just
00:01:21
don't wanna do it again and not contend and they're scared and do not try
00:01:26
to talk them into this then we had some uh complications related anaesthesia
00:01:32
the only actually um relevant real um complication was a
00:01:37
eighty seven real patient with a coronary still terms
00:01:40
that occurred about three hours after the injection we transferred into the operating room
00:01:45
um there was improvement over a application might roll they would know changes
00:01:51
in the u. t. g. m. yet no signs of major
00:01:54
my card and faction and actually was just fine after the usual universe you work up
00:01:59
so you've insisted on going forward with the procedure we did off another three hours
00:02:04
he's was really pleased and now he's scheduled to have his condor lateral side released also
00:02:09
further complicate a complication for mainly skin reactions like too
00:02:13
slow or decreases satellite is this just inflammation
00:02:17
and some patients just a complaint about persisting swelling for more than
00:02:22
a week up the a probably a one probably really is
00:02:24
and this is the the first where's that we saw are the worst rash that we so often yeah i transfer
00:02:30
um we use the dosage that it well is given in the lawn spoke
00:02:36
um we have been reducing out those to significantly since then so i
00:02:42
think we can get away with about half of the those age um
00:02:46
but that was the worst rash we see in all these years
00:02:50
we had two cases that we had to convert to general
00:02:53
anaesthesia actually during the operation um this but most cases
00:02:58
that had severe um trauma beforehand and as you can see here that's nice
00:03:03
glancing up this skin so the best construction works but the anaesthesia
00:03:08
just wasn't complete so the median nerve just what number up
00:03:11
then we can go in and it was a major mess in there as you can
00:03:15
see 'em but uh what it within the and the and it worked out
00:03:20
another limit that we so we ask les injuries or confusion problems so
00:03:25
this is the patient was presented to me sixty minutes after
00:03:28
the injection by the resident in the operating room
00:03:32
and obviously you can just start operating on him so what we did is we shortly apply to try to
00:03:39
get to put the micro vascular climb on and then we could deceitful with the procedure you wide awake
00:03:45
so i just learned that from where you last surgery for this it's a
00:03:50
shorts today get three put on and then we perform the micro surgery
00:03:54
no problems and just to prove that is actually wide awake
00:03:58
we made the patients movies fingers after what i so
00:04:03
um profusion varies a lot during balance surgery as you
00:04:08
can see yeah you can have patients that have
00:04:10
no profusion at all have the logic papacy to some something in between and you can he see
00:04:15
a good pause here and a normal pages the test so you can't really rely on this
00:04:21
um you can do best was surgery obviously but you should
00:04:25
align the profusion afterwards so limits of whale and some
00:04:29
patience just can't cope with the situation uh in our experience
00:04:34
i think you should not try to persuade them
00:04:37
local aesthetics have conjured occasions to um you should respect the obviously
00:04:43
i'm in cases of massive scarring in we had two cases that
00:04:47
we just couldn't really get complete diffusion of the and static
00:04:52
so you should be aware that and that's good surgeries possible but the profusion is
00:04:58
very variable and you should not be used in compromise digits thank you of
00:05:10
thanks for having a nice set paper
00:05:12
actually i i have a question for long quite nice pass and that's something we should be afraid i'll
00:05:20
yeah
00:05:23
oh yes
00:05:27
huh huh uh so most people won't have problems
00:05:33
with a coronary issues but look it's possible
00:05:37
people have heart attacks walking down the street they have heart attacks in their sleep
00:05:41
if we do enough wide awake surgery somebody's gonna have a heart attack during
00:05:45
the surgery whether or not it's caused by the epitaph from maybe
00:05:50
but you know i think that if you're worried we should always be safe if you have
00:05:54
somebody has heart problems we take them to the operating room and do them with monitoring
00:05:59
and you can decrease the concentration of the open after and if they have that her problems you can go to one
00:06:05
quarter percent white cane with one four hundred thousand happen after and and that's going
00:06:10
to work very well but i i really wanna thank you for pointing out
00:06:14
but there are limitations this isn't for everybody not every patient
00:06:18
is suitable i did what people have been asking me for years have you ever had anybody who's had a panic attack
00:06:25
and i never have until this year two months ago i had a patient have a panic attack during the surgery
00:06:31
and we got through it and talked or through it and everything but with twenty twenty rector scrap equation she
00:06:37
might have been one it's better to put to sleep but you also made a good point of
00:06:41
when there's a lot of scarring in the poll the local anaesthesia
00:06:45
does not diffuse easily and so in those cases you
00:06:49
almost have to have a pretty good proximal block to so thank you for pointing that out i appreciate them
Conference Program
A-0099 The creation of a Wide Awake Hand Surgery service in an NHS Trust in the UK. Challenges, cost savings and effectiveness
Constantinos Kritiotis, Manchester, UK
June 14, 2018 · 8:23 a.m.
A-0099 Q&A
Constantinos Kritiotis, Manchester, UK
June 14, 2018 · 8:29 a.m.
A-0140 Benefits of the Implantation of a "Wide Awake Surgery" Circuit in Hand Surgery
Ana M. Far-Riera, Hospital Son Llàtzer, Palma De Mallorca, Islas Baleares, Spain
June 14, 2018 · 8:31 a.m.
A-0719 Wide Awake Hand Surgery - Limits and Complications
Kai Megerle, Julia Jakobus, Ursula Kraneburg, Hans-Gunther Machens, Clinic for Plastic Surgery and Hand Surgery, Technical University of Munich, Munich, Germany
June 14, 2018 · 8:36 a.m.
262 views
A-0024 Clinical evaluation of surgical management of hand pathologies under local anesthesia
Juanos Cabanas Jordi, Schuind Frederic, Jennart Harold, Zorman David, CHU Tivoli, La Louvière (Belgium); Erasme Hospital, Brussels (Belgium)
June 14, 2018 · 8:43 a.m.
118 views
A-0043 Scope in Hand Surgery Using Surgeon Administered Local/Regional Anaesthesia (SALoRA)
Sim Wei Ping, Tan Shoun, Vaikunthan Rajaratnam, Khoo Teck Puat Hospital, Singapore
June 14, 2018 · 8:51 a.m.
137 views
A-0853 The advantages of using WALANT anesthesia for hand and wrist fractures- personal experience
Daniel Vilcioiu 1, Dragos Zamfirescu 2, Andrei Ursache 1, Ioan Cristescu 1, 1 Clinical Emergency Hospital of Bucharest, Bucharest, Romania; 2 Zetta Clinic, Bucharest, Romania
June 14, 2018 · 8:58 a.m.
A-0554 Wide awake flexor pollicis longus and digital nerve repairs on patients in the prone position
Thomas Apard 1, Yann Erwan Favennec 1, Gilles Candelier 1, Daniel Mckee 2, Donald H. Lalonde 2, 1 Center of Hand Surgery, Private Hospital of Saint Martin, Caen, France; 2 Plastic Surgery, Dalhousie University, Saint John, New Brunswick, Canada
June 14, 2018 · 9:06 a.m.
A-0075 Correlation between Extension-Block K-wire Insertion Angle and Postoperative Extension Loss in Mallet Finger Fracture
Sang Ki Lee 1, Youn Moo Heo 2, 1 Eulji University College of Medicine, Daejeon, Korea; 2 Konyang University College of Medicine, Daejeon, Korea
June 14, 2018 · 9:13 a.m.
A-0143 WALANT for tendon transfers after neglected peripheral nerve and shoulder plexus injuries
Sergii Strafun, Andrii Lysak, Artur Bezuhlyi, Sergii Tymoshenko, Mykola Oberemok, State institution "Institute of Traumatology and Orthopedics of NAMS of Ukraine", Kyiv, Ukraine
June 14, 2018 · 9:20 a.m.
A-0114 Reconstruction of ulnar dislocation of the extensor tendon at the metacarpophalangeal joint
Masayoshi Ikeda 1,2, Yuka Kobayashi 2, Takehiko Takagi 2, Ikuo Saito 2,3, Takayuki Ishii 2, Daisuke Nakajima 2, Masahiko Watanabe 2, 1 Shonan Central Hospital, Fujisawa, Japan; 2 Tokai University School of Medicine, Isehara, Japan; 3 Isehara Kyodo Hospital, Isehara, Japan
June 14, 2018 · 9:28 a.m.
183 views
A-1022 Lumbrical plus or paradox finger extension syndrome - case report and review of the literature
Andreas Gohritz, Dirk J. Schaefer, Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, University Hospital, Basel, Switzerland
June 14, 2018 · 9:35 a.m.
475 views
A-1025 Saddle deformity: a case report
David Jann, Maurizio Calcagni, Thomas Giesen, University Hospital Zurich, Switzerland
June 14, 2018 · 9:44 a.m.
241 views
