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Updated: Oct 18, 2025

Vascularized Composite Hand Allograft Procurement and Preparation for Distal and Proximal Forearm Allotransplantation: A Stepwise Approach
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WALANT Hand Surgery: Do the AORN Guidelines Apply?

Alba Avoricani1, Qurratul-Ain Dar1, Kenneth H Levy1

  • 1Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, Brooklyn, New York.

Journal of Surgical Orthopaedic Advances
|September 30, 2021
PubMed
Summary
This summary is machine-generated.

This study on wide-awake local anesthesia no tourniquet (WALANT) hand surgery found a low complication rate with a single circulating nurse. Findings suggest this approach may improve efficiency and reduce costs in hand surgery settings.

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Area of Science:

  • Orthopedic Surgery
  • Anesthesiology
  • Perioperative Nursing

Background:

  • Current guidelines by the Association of Perioperative Nurses (AORN) often mandate two nurses for local anesthesia procedures.
  • Hand surgeries under wide-awake local anesthesia no tourniquet (WALANT) are increasingly performed in outpatient settings.
  • Optimizing staffing and efficiency in WALANT procedures is crucial for cost-effectiveness and patient flow.

Purpose of the Study:

  • To evaluate the safety and efficacy of the WALANT technique in hand surgery.
  • To assess surgical complication and infection rates in a cohort of WALANT hand surgeries.
  • To determine if a reduced nursing staff (one circulating nurse) is feasible and safe for WALANT procedures.

Main Methods:

  • Retrospective review of 217 patients and 265 WALANT hand surgeries in an outpatient setting.
  • Operations performed with a single surgeon, one resident, and one circulating nurse.
  • Documentation of all intraprocedural complications and postoperative surgical site infections (SSIs).

Main Results:

  • Zero intraprocedural complications were reported.
  • Zero superficial SSIs occurred.
  • A single deep SSI (0.37% incidence) was observed and successfully treated.

Conclusions:

  • The WALANT technique for hand surgery demonstrates a low incidence of complications and infections.
  • Utilizing a single circulating nurse during WALANT hand surgeries appears safe and effective.
  • This staffing model may enhance nurse staffing flexibility, improve turnover efficiency, and reduce procedural costs.