A Study of Hand Flap Viability when Using a Wide Awake Local Anesthesia No Tourniquet (WALANT) Technique

Abstract

Objectives Flap surgery using a wide awake local anesthesia no tourniquet (WALANT) technique has historically been avoided because of technical challenges and concerns regarding the vasoconstriction caused by the necessary injection of epinephrine alongside the local anesthetic. The objective of our work was to evaluate the viability of the hand flaps performed using a WALANT technique compared with those performed under regional with a tourniquet.

Materials and Methods Seventy-four patients were enrolled in a prospective comparative single-center study and subsequently divided into two groups: 36 patients in the locoregional anesthesia group and 38 patients in the WALANT group. Flap viability was evaluated on day 2 and day 10 using predetermined criteria.

Results We did not find any significant difference in outcomes assessed for flap viability between the two groups postoperatively.

Conclusion There was no evidence to suggest that vascularization of the flaps was compromised by the injection of epinephrine. The WALANT technique may, therefore, potentially be able to be safely deployed within this population.

Keywords

anesthesia - flaps - viability

Ethical Approval

Ethical approval for this study was obtained from CLEP Decision No: AAA-2018–08006 Local Ethics Committee for the Cochin Hospital Publications. Address: Site Cochin; 27, rue du Faubourg Saint-Jacques; 75679 PARIS Cedex 14; [e-mail]

Statement of Human and Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (human and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed Consent

Informed consent was obtained from all patients for being included in the study.

Authors' Contribution

C. P. contributed to the inception of concept and data collection and analysis, writing the manuscript and reviewing the literature. L.M. contributed to data collection and analysis, literature review, and writing the manuscript. S.A.H. contributed to data analysis, literature review, writing the manuscript, and preparing the publication; French-English language translation and verification throughout. T.G. contributed to the inception of the concept, joint study lead, and data collection. C.D. contributed to the inception of the concept, joint study lead, and data collection.

Publication History

Article published online:
23 February 2022

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