Reconstruction of the hand with wide awake surgery

Wide awake hand surgery means no sedation, no tourniquet, and no general anesthesia for hand surgery. The only medications given to the patient are lidocaine with epinephrine. Lidocaine is for anesthesia, and epinephrine provides hemostasis, which deletes the need for a tourniquet. The advantages are: (1) the ability of the comfortable unsedated tourniquet-free patient to perform active movement of the reconstructed structures during surgery so the surgeon can make alterations to the reconstruction before the skin is closed to improve the outcome of many surgeries; and (2) the deletion of all risks, costs, and inconveniences of sedation and general anesthesia.