Gabay Talia, Jia Yu Fei, de Frey Neena, Ramothata Tebogo, Maisela Chikonde, Colloty Antionette, Maseko Nehume Thandie, Kgagudi Marule Paul
Orthopedic Surgery, Wits University, Johannesburg, ZAF.
Cureus. 2025 Aug 15;17(8):e90198. doi: 10.7759/cureus.90198. eCollection 2025 Aug.
Musculoskeletal trauma remains on the rise, particularly in low- and middle-income countries (LMICs). Hand injuries are equally prevalent, with patients in LMICs being 5 to 10 times more likely to be affected. Patients who sustain hand injuries are at risk of experiencing temporary or permanent loss of hand function, severely impacting activities of daily living. Early treatment intervention can reduce the risk of long-term disability. The Wide Awake Local Anesthesia No Tourniquet (WALANT) technique, since its development, has revolutionized hand surgery with reported benefits. Our study aimed to analyze the scope of hand pathologies treated under WALANT and its associated failure rate and complications in our context.
We conducted a retrospective clinical audit of patients treated for hand pathology with WALANT at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) between 1 July and 31 December 2016. Demographic, pathology, and intraoperative data were collected from the hospital admissions, ward, and theater records of patients who met our inclusion criteria. Procedure waiting times and length of hospital stay were calculated from recorded dates and times. All collected data were de-identified and handled using REDCap (Vanderbilt University, Nashville, TN, USA) and Microsoft Excel version 16.51 (Microsoft Corp., Redmond, WA, USA) for storage and analysis. Descriptive statistics were employed, with measures of central tendency (mean, median, mode) and dispersion (standard deviation) calculated using the Data Analysis ToolPak in Microsoft Excel.
Data for 416 patients were included for analysis after all exclusions. The majority of patients were Black males. Employed individuals and the right hand were affected slightly more than the unemployed and the left hand, respectively. The fingers were affected slightly more than the hand (234 (22.6%); 163 (19.47%)), and infections (152 (36.54%)) were more frequently treated, followed by lacerations (131 (31.49%)). The average procedure waiting time and the length of hospital stay were significantly low, with an equally low complication (4/416 (0.96%)) and failure rate (91/416 (22.12%)).
The practical advantages and clinical safety of WALANT in the South African context provide valuable insights into its role in enhancing healthcare delivery in LMICs. Our study demonstrated a high success rate, minimal complications, and significant cost-effectiveness in a broad scope of hand pathologies treated surgically under WALANT. This study contributes to the growing body of evidence supporting WALANT as a viable solution for managing hand conditions in settings where traditional methods, such as the use of general anesthesia and the availability of a theater, are often limited by financial and logistical constraints.
肌肉骨骼创伤的发生率持续上升，在低收入和中等收入国家（LMICs）尤为明显。手部损伤同样普遍，LMICs的患者受影响的可能性要高出5至10倍。手部受伤的患者有暂时或永久丧失手部功能的风险，这对日常生活活动有严重影响。早期治疗干预可以降低长期残疾的风险。清醒局部麻醉无止血带（WALANT）技术自问世以来，给手部手术带来了变革，并带来了诸多益处。我们的研究旨在分析在我们的环境中，采用WALANT治疗的手部病理范围及其相关的失败率和并发症。
我们对2016年7月1日至12月31日期间在夏洛特·马克西克·约翰内斯堡学术医院（CMJAH）接受WALANT治疗手部疾病的患者进行了回顾性临床审计。从符合纳入标准的患者的医院入院、病房和手术室记录中收集人口统计学、病理和术中数据。根据记录的日期和时间计算手术等待时间和住院时间。所有收集的数据均进行了去识别处理，并使用REDCap（美国田纳西州纳什维尔范德比尔特大学）和Microsoft Excel 16.51版（美国华盛顿州雷德蒙德微软公司）进行存储和分析。采用描述性统计方法，使用Microsoft Excel中的数据分析工具包计算集中趋势（均值、中位数、众数）和离散度（标准差）的指标。
经过所有排除后，纳入416例患者的数据进行分析。大多数患者为黑人男性。就业人员和右手受影响的比例略高于失业人员和左手。手指受影响的比例略高于手部（234例（22.6%）；163例（19.47%）），感染（152例（36.54%））的治疗更为频繁，其次是撕裂伤（131例（31.49%））。平均手术等待时间和住院时间显著较短，并发症（4/416例（0.96%））和失败率（91/416例（22.12%））同样较低。
WALANT在南非环境中的实际优势和临床安全性，为其在改善LMICs医疗服务中的作用提供了宝贵见解。我们的研究表明，在WALANT手术治疗的广泛手部病理范围内，成功率高、并发症极少且具有显著的成本效益。这项研究为越来越多的证据做出了贡献，支持WALANT作为在传统方法（如全身麻醉的使用和手术室的可用性）常常受到资金和后勤限制的环境中管理手部疾病的可行解决方案。
