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Can WALANT be used for complex procedures? Robyn Midgley talks to Dr Alistair Philips, Co-Founder of

'There is no actual limit to extremity surgery that can be performed with WALANT but the benefits are very different for different surgeons and the different healthcare systems in which we work. For some it’s cost, for others it’s efficiency and for others it’s for patient education and engagement. For all it’s about checking intra-operative motion and making sure the operation has been successful BEFORE we all leave theatre. Having had my own successful WALANT surgery on my hand it was the knowledge that after so much pain (mental and emotional) and uncertainty that I was now fixed and could work again. We have ignored the psychological aspects of surgery for too long and the qualitative benefits are ubiquitous to all WALANT operations. There is no greater evidence than when the patient comes to the Out Patient Department to see their Hand Therapist with intricate knowledge of the procedure they have had done, is able to show you the video of the operation (I always let my patients film or use social media intra-operatively) and feels confident about their rehabilitation because they have participated in their procedure and have been educated by their surgeon. All of this means that you can rehabilitate them better. It’s a team sport and the traditional model has left the main player out for too long. It’s time to put the patient at the centre of the team as it’s the star who can score all the goals with a little bit of help from us'. Dr Philips

'Thank you for those insights Dr Philips. It always changes our perspective when we become the patient and get first hand experience of the emotional and physical stresses associated with a hand injury. The hand surgeon that I work with, Dr Chetan Patel, started using WALANT after listening to Dr Lalonde present at our local Hand Surgery & Therapy Refresher Course in February 2019. Dr Patel used the technique on a patient who had a Zone III FDS & FDP repair to her index finger. Very often, I am present during the operation and we also take intra-operative video's which we share on social media. We have found this to be enormously beneficial to the medical and lay community. We decided to use the confidence we gained in seeing the repair in action before closing the wound to adapt our post operative protocol. For a long time we agreed that the patient needed to work into a hook fist with the MCP joints in neutral and into a half fist immediately post op in order to achieve a better functional outcome. With WALANT we felt confident to do this and did get an excellent result.

As a hand therapist, I am very excited by the prospect of surgeon's moving to WALANT. As a team we can save the patient time and money when it comes to their operation as well as their therapy. , Furthermore, as we often refer patients for surgery, we can assist with getting them to understand this new way of operating and encourage them to consent to the procedure before they see the surgeon. I applaud you and Dr Lalonde for being so innovative and for making the next decade of surgery and therapy seem limitless with possibilities. As you say, let's spark the next round of WALANT explosion!' Robyn Midgley:

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