Chapter 23 Dupuytren′s Contracture
ADVANTAGES OF WALANT VERSUS SEDATION AND TOURNIQUET IN DUPUYTREN′S CONTRACTURE
With the wide awake approach, you can see how much active extension the patient can really achieve after cord resection and before the skin is closed. You and the patient both find out during surgery whether or not the patient is likely to regain full active extension, thus avoiding the patient′s having unrealistic expectations after surgery.
Many of these patients are older and could have problems with general anesthesia and sedation because of medical comorbidities. With WALANT, they will just get up and go home as they do after they have a dental procedure.
Patients get to see that the cord and nodule are gone as they watch themselves moving their fingers through a full range of motion before the skin is closed. They realize that their fingers can work well once they get past the postoperative discomfort and stiffness.1,2
Procedures requiring correction of multiple digits and revisions are not time limited by the use of a tourniquet.
When a patient is being treated for recurrent Dupuytren′s contracture, his or her mindset may be quite different than during a primary surgery for the condition. The patient may feel that during the initial repair there was minimal follow-up and perhaps not enough discussion about the fact that the disease would likely recur in the future. The wide awake procedure allows you to have a prolonged consultation with the patient during the surgery to discuss the recurrent nature of this condition and postoperative rehabilitation options.
All of the general advantages listed in Chapter 2 apply to both the surgeon and the patient.
WHERE TO INJECT THE LOCAL ANESTHETIC FOR DUPUYTREN′S CONTRACTURE
See Chapter 1, Atlas, for more illustrations of the anatomy of diffusion of tumescent local anesthetic in the forearm, wrist, and hand.