Postoperative follow-up time and justification in prospective hand surgery research: a systematic review

Should 6- or 12-month outcomes be used after carpal tunnel decompression?

Preoperative and 6- and 12-month postoperative Quick version of the Disablities of the Arm, Shoulder and Hand (QuickDASH) scores for 336 patients undergoing carpal tunnel decompression were 43.2, 18.2 and 15.9, respectively. There was no significant improvement in QuickDASH between 6 and 12 months. Postoperative scores should not be collected at both end points.

Operative outcomes for wide awake local anesthesia versus regional and general anesthesia for flexor tendon repair

Operative repair of flexor tendons after traumatic injury may be performed under general anesthesia (GA), regional blocks, or a wide-awake local anesthesia no tourniquet (WALANT) technique. To our knowledge there are currently no large-scale reports evaluating outcomes of flexor tendon repair in patients where wide-awake anesthesia was utilized in comparison to regional anesthesia (RA) and general anesthesia. We performed a retrospective analysis of patients who underwent treatment for flexor tendon injuries at a tertiary referral center for hand surgery over a two-year period. A total of 151 patients were included (53 WALANT, 57 RA, and 41 GA) and a total of 251 tendons were repaired (63 WALANT, 104 RA and 84 GA). No statistically significant difference was observed in rates of tendon rupture, adhesions, infection, or hand function. Flexor tendon repair under WALANT is found to be safe and presents comparable operative and functional outcomes to more traditional anesthetic techniques. Additional advantages, including the ability to test the repair intraoperatively, patient education, and the potential for boosting theatre efficiency. Further studies, preferably utilizing a randomized trial methodology, may further elucidate the benefits and risks of WALANT versus regional and general anesthesia.