Hand surgery without tourniquet as a model for the development of surgical service innovation for competitive advantage-based service readiness

  • Theddeus Octavianus Hari Prasetyono Medical Journal of Indonesia; Department of Surgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia; Indonesian Clinical Training and Education Center (ICTEC), Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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  1. Ministry of Health of the Republic of Indonesia. [2018 Riskesdas national report]. Jakarta: Ministry of Health of the Republic of Indonesia; 2019. Indonesian.

  2. Crowe CS, Massenburg BB, Morrison SD, Chang J, Friedrich JB, Abady GG, et al. Global trends of hand and wrist trauma: a systematic analysis of fracture and digit amputation using the Global Burden of Disease 2017 Study. Inj Prev. 2020;26(Supp 1):i115-24.

  3. Gordon AM, Malik AT, Goyal KS. Trends of hand injuries presenting to US emergency departments: a 10-year national analysis. Am J Emerg Med. 2021;50:466-71. https://doi.org/10.1016/j.ajem.2021.08.059

  4. Wang Y, Beekman J, Hew J, Jackson S, Issler-Fisher AC, Parungao R, et al. Burn injury: challenges and advances in burn wound healing, infection, pain and scarring. Adv Drug Deliv Rev. 2018;123:3-17. https://doi.org/10.1016/j.addr.2017.09.018

  5. Hwang YF, Chen-Sea MJ, Chen CL. Factors related to return to work and job modification after a hand burn. J Burn Care Res. 2009;30(4):661-7. https://doi.org/10.1097/BCR.0b013e3181abfabf

  6. Tang ZH, Rajaratnam V, Desai V. Incidence and anatomical distribution of hand tumours: a Singapore study. Singapore Med J. 2017;58(12):714-6. https://doi.org/10.11622/smedj.2016147

  7. AbuMoussa S, Roshan MP, Souza FF, Daley D, Rosenberg A, Pretell J, et al. Soft tissue masses of the hand: a review of clinical presentation and imaging features. Curr Oncol. 2023;30(2):2032-48. https://doi.org/10.3390/curroncol30020158

  8. Vaughn N, Rajan N, Darowish M. Intravenous regional anesthesia using a forearm tourniquet: a safe and effective technique for outpatient hand procedures. Hand (N Y). 2020;15(3):353-9. https://doi.org/10.1177/1558944718812190

  9. Lalonde D. Wide awake local anaesthesia no tourniquet technique (WALANT). BMC Proc. 2015;9(Suppl 3):A81. https://doi.org/10.1186/1753-6561-9-S3-A81

  10. Fitzcharles-Bowe C, Denkler K, Lalonde D. Finger injection with high-dose (1:1,000) epinephrine: does it cause finger necrosis and should it be treated? Hand (N Y). 2007;2(1):5-11. https://doi.org/10.1007/s11552-006-9012-4

  11. Chowdhry S, Seidenstricker L, Cooney DS, Hazani R, Wilhelmi BJ. Do not use epinephrine in digital blocks: myth or truth? Part II. A retrospective review of 1111 cases. Plast Reconstr Surg. 2010;126(6):2031-4. https://doi.org/10.1097/PRS.0b013e3181f44486

  12. Wilhelmi BJ, Blackwell SJ, Miller JH, Mancoll JS, Dardano T, Tran A, et al. Do not use epinephrine in digital blocks: myth or truth? Plast Reconstr Surg. 2001;107(2):393-7. https://doi.org/10.1097/00006534-200102000-00014

  13. Lalonde D, Martin A. Epinephrine in local anesthesia in finger and hand surgery: the case for wide-awake anesthesia. J Am Acad Orthop Surg. 2013;21(8):443-7. https://doi.org/10.5435/JAAOS-21-08-443

  14. Lalonde D, Bell M, Benoit P, Sparkes G, Denkler K, Chang P. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie Project clinical phase. J Hand Surg Am. 2005;30(5):1061-7. https://doi.org/10.1016/j.jhsa.2005.05.006

  15. Farhangkhoee H, Lalonde J, Lalonde DH. Teaching medical students and residents how to inject local anesthesia almost painlessly. Can J Plast Surg. 2012;20(3):169-72. https://doi.org/10.1177/229255031202000315

  16. Lalonde DH. Evidence-based medicine: carpal tunnel syndrome. Plast Reconstr Surg. 2014;133(5):1234-40. https://doi.org/10.1097/PRS.0000000000000092

  17. Lalonde DH. Wide-awake flexor tendon repair. Plast Reconstr Surg. 2009;123(2):623-5. https://doi.org/10.1097/PRS.0b013e318195664c

  18. Lalonde DH, Martin AL. Wide-awake flexor tendon repair and early tendon mobilization in zones 1 and 2. Hand Clin. 2013;29(2):207-13. https://doi.org/10.1016/j.hcl.2013.02.009

  19. Lalonde DH. Reconstruction of the hand with wide awake surgery. Clin Plast Surg. 2011;38(4):761-9. https://doi.org/10.1016/j.cps.2011.07.005

  20. Al Youha S, Lalonde DH. Update/review: changing of use of local anesthesia in the hand. Plast Reconstr Surg Glob Open. 2014;2(5):e150. https://doi.org/10.1097/GOX.0000000000000095

  21. Prasetyono TO. Tourniquet-free hand surgery using the one-per-mil tumescent technique. Arch Plast Surg. 2013;40(2):129-33. https://doi.org/10.5999/aps.2013.40.2.129

  22. Prasetyono TO, Koswara AF. Linear hand burn contracture release under local anesthesia without tourniquet. Hand Surg. 2015;20(3):484-7. https://doi.org/10.1142/S0218810415720272

  23. Seretis K, Boptsi A, Boptsi E, Lykoudis EG. The efficacy of wide-awake local anesthesia no tourniquet (WALANT) in common plastic surgery operations performed on the upper limbs: a case-control study. Life (Basel). 2023;13(2):442. https://doi.org/10.3390/life13020442

  24. Sardenberg T, Ribak S, Colenci R, Campos RB, Varanda D, Cortopassi AC. 488 hand surgeries with local anesthesia with epinephrine, without a tourniquet, without sedation, and without an anesthesiologist. Rev Bras Ortop. 2018;53(3):281-6. https://doi.org/10.1016/j.rbo.2017.04.007

  25. Fouché TW, Bond SM, Vrouwe SQ. Comparing the efficiency of tumescent infiltration techniques in burn surgery. J Burn Care Res. 2022;43(3):525-9. https://doi.org/10.1093/jbcr/irac026

  26. Shahid S, Saghir N, Saghir R, Young-Sing Q, Miranda BH. WALANT: a discussion of indications, impact, and educational requirements. Arch Plast Surg. 2022;49(4):531-7. https://doi.org/10.1055/s-0042-1748659

  27. Prasetyono TO, Pribadi S. Systematic injection patterned-technique of one-per-mil tumescent solution for perforator-based skin flap: is it better than the random patterned-technique? Int Surg. 2015;100(9-10):1308-14. https://doi.org/10.9738/INTSURG-D-14-00290.1

  28. Zeng Q, Zou D, Hu YG, Yu BF. Is full-awake local anesthesia no-tourniquet hand surgery more suitable for major flexor tendon trauma? Ann Plast Surg. 2020;85(2):202. https://doi.org/10.1097/SAP.0000000000002151

  29. Meals CG, Chang J. Ten tips to simplify the spaghetti wrist. Plast Reconstr Surg Glob Open. 2018;6(12):e1971. https://doi.org/10.1097/GOX.0000000000001971

  30. Huang HF, Matschke J. Digit replantation under wide-awake local anesthesia. Plast Reconstr Surg. 2022;149(1):143-9. https://doi.org/10.1097/PRS.0000000000008609

  31. Klein JA. Anesthetic formulation of tumescent solutions. Dermatol Clin. 1999;17(4):751-9, v-vi. https://doi.org/10.1016/S0733-8635(05)70124-8

  32. Thomas AB, Shammas RL, Orr J, Truong T, Kuchibhatla M, Sergesketter AR, et al. An assessment of bleeding complications necessitating blood transfusion across inpatient plastic surgery procedures: a nationwide analysis using the national surgical quality improvement program database. Plast Reconstr Surg. 2019;143(5):1109e-17e. https://doi.org/10.1097/PRS.0000000000005537

  33. Lalonde DH. Conceptual origins, current practice, and views of wide awake hand surgery. J Hand Surg Eur Vol. 2017;42(9):886-95. https://doi.org/10.1177/1753193417728427

  34. Porter ME. The competitive advantage: creating and sustaining superior performance. New York: Free Press; 1985.

  35. Sigalas C. Competitive advantage: the known unknown concept. Manag Decis. 2015;53(9):2004-16. https://doi.org/10.1108/MD-05-2015-0185

  36. International Society of Aesthetic Plastic Surgery (ISAPS). Global survey 2022: ISAPS international survey on aesthetic/cosmetic procedures performed in 2022 [Internet]. International Society of Aesthetic Plastic Surgery (ISAPS); 2022 [cited 2023 Oct 6]. Available from: https://www.isaps.org/media/a0qfm4h3/isaps-global-survey_2022.pdf.

  37. Lecture of the President of KSPRS in the 15th Japan-Korea Congress of Plastic Reconstructive Surgery, Fukuoka, Japan. May 29-31, 2023. Personal Communication.

  38. Heidhues P, Kőszegi B, Murooka T. Inferior products and profitable deception*. Rev Econ Stud. 2017;84(1):323-56. https://doi.org/10.1093/restud/rdw037

  39. Maijala H, Munnukka T, Nikkonen M. Feeling of 'lacking' as the core of envy: a conceptual analysis of envy. J Adv Nurs. 2000;31(6):1342-50. https://doi.org/10.1046/j.1365-2648.2000.01428.x

  40. Akbar FH, Krishnan V, Yusoh MP. Dental tourism in Bali Province, Indonesia. Neuroquantology. 2022;20(1):340-7. https://doi.org/10.14704/nq.2022.20.1.NQ22301

  41. Prithari GA, Setiawan I, Kuswoyo C. [The effect of service quality on expatriate patients' satisfaction at Bali International Dental Center]. Padjadjaran J Dent Res Student. 2018;2(2):80-6. Indonesian. https://doi.org/10.24198/pjdrs.v1i1.22127

  42. Clerkin RM, Coggburn JD. The dimensions of public service motivation and sector work preferences. Rev Public Pers Adm. 2012;32(2):209-35. https://doi.org/10.1177/0734371X11433880

How to Cite
Prasetyono TOH. Hand surgery without tourniquet as a model for the development of surgical service innovation for competitive advantage-based service readiness. Med J Indones [Internet]. 2024Mar.4 [cited 2024May22];33(1):3-. Available from: https://mji.ui.ac.id/journal/index.php/mji/article/view/7399