Wide awake Dupuytren’s fasciectomy: A pathoanatomical approach

Abstract

Wide awake hand surgery is performed under local anaesthesia with low-dose adrenaline without (the risks of) general anaesthesia, regional anaesthesia, sedation or tourniquets, is applicable to the majority of hand surgery procedures and is especially suited to soft tissue conditions including Dupuytren’s contracture (Bismil et al., World wide awake hand surgery consensus statement. http://www.worldwideawake.net/3.html http://www.worldwideawake.net/3.html Wide awake hand surgery is gaining increasing popularity worldwide because of the opportunities it provides to optimise surgery and rehabilitation [Lalonde, J Hand Ther 26(2):175-178, 2013], streamline the patient pathway [Bismil et al., JRSM Short Rep 3(4):23, 2012], and give patient-centred care with excellent outcomes and patient satisfaction [Bismil et al., JRSM Short Rep 3(4):23, 2012; Teo et al., J Hand Surg Eur Vol 38(9):992-999, 2013]. The continued evolution of wide awake hand surgery relies on worldwide collaboration among surgeons, therapists and not least hand surgery patients who recognise the potential advantages of the techniques. Wide awake Dupuytren’s fasciectomy is the product of such worldwide collaboration, with patients at the centre. The origins of wide awake fasciectomy for Dupuytren’s contracture can be traced to the early 1980s when TH Robbins, an Australian plastic surgeon, published, in the Annals of the Royal College of Surgeons of England, a paper on Dupuytren’s Z-plasty under local anaesthesia [Robbins, Ann R Coll Surg Engl 63(5):357-358, 1981]. Subsequently, centres in Canada [Denkler, Plast Reconstr Surg 115(3):802-810, 2005], the United States [Nelson et al., Hand (N Y) 5(2):117-124, 2010] and the United Kingdom [Bismil et al., JRSM Short Rep 3(7):48, 2012] have published their results.