Wide awake hand surgery for conditions like Dupuytren’s: What to expect from a specialist WALANT procedure

Wide Awake Local Anaesthesia No Tourniquet (WALANT) is transforming the way we approach hand surgery. Particularly useful for conditions like Dupuytren’s contracture, carpal tunnel syndrome and trigger finger, WALANT allows procedures to be performed safely and comfortably without the need for general anaesthetic.

In this article, consultant plastic surgeon Ms Tereze Laing explains what patients can expect before, during, and after a WALANT procedure.

What is WALANT hand surgery?

WALANT is a technique that uses local anaesthetic with adrenaline to numb the surgical area while reducing bleeding, eliminating the need for both sedation and a tourniquet. This approach allows patients to remain awake and pain-free during the operation.

It’s especially useful in hand surgery, where patient movement or feedback can help improve results. For conditions such as Dupuytren’s disease, which causes the fingers to curl inwards, WALANT provides a highly effective solution with quicker recovery.

Before the procedure: Preparing for WALANT surgery

During your consultation, your surgeon will examine your hand and determine if WALANT is appropriate. You’ll be informed of the benefits and any limitations of the approach, as well as what to expect on the day.

You’ll be given information about the procedure, including what to expect, how to prepare, and any medications to avoid beforehand.

During the procedure: What to expect

The local anaesthetic is injected using a fine needle, which may sting briefly. Within minutes, the area to be operated on becomes fully numb. The addition of adrenaline minimises bleeding and improves visibility for the surgeon, making the use of a tight tourniquet unnecessary.

You’ll feel no pain during surgery, though you may be aware of touch or movement. Most patients find the experience surprisingly relaxed.

Why being awake helps

Being awake allows real-time assessment of finger movement or tendon function during surgery, which is particularly valuable in procedures like tendon repair or contracture release. It also avoids the potential complications of general anaesthesia, making it suitable for older adults or those with medical conditions.

After the procedure: Recovery and results

Most WALANT patients go home within an hour of surgery. The hand will remain numb for a few hours, after which some mild discomfort may begin. This is usually manageable with simple painkillers.

Some swelling or bruising is normal. Keeping the hand elevated in the first 24–48 hours helps reduce this.

Follow-up and hand therapy

Depending on the procedure, you may be advised to start gentle movement exercises straight away or attend hand therapy sessions. Your surgeon will give personalised guidance and arrange any necessary follow-up appointments.

For Dupuytren’s contracture, WALANT enables precise release and excellent functional results, often with a faster return to daily activities.

WALANT offers a safe, effective, and minimally invasive option for many hand conditions.

If you are considering hand surgery, consult with Ms Laing via her Top Doctors profile to determine whether WALANT is the right option for you.