[Possibilities and limits of ambulatory surgery--demands and reality in hand surgery]

There are many procedures in hand surgery that from the point of view of a hospital staff member do not seem possible or practical to perform in an out-patient setting, yet can nevertheless safely be done in that fashion. The personal situation in regard to the necessary training and up to date knowledge, as well as resources in man power and technical equipment require realistic assessment to be able to determine the limits in which ambulatory surgery can be conducted safely. The hardest factor to calculate always remains the patient, who in an out-patient setting easily can evade the necessary control by the surgeon. Therefore, it is of surmount importance to achieve a mutual understanding between patient and physician. This must be based on comprehensive counselling regarding the problem and the surgical procedure including not only all risks and possible complications, but also emphasising postoperative measures. Only by achieving such a relation can ambulatory hand surgery be performed safely, with efficacy, and--above all--with low complication rates.