A Retrospective Analysis of Hand Conditions Treated Using the Wide Awake Local Anesthesia No Tourniquet (WALANT) Technique at a Teaching Hospital

Background: Musculoskeletal trauma remains on the rise, particularly in low- and middle-income countries (LMICs). Hand injuries are equally prevalent, with patients in LMICs being 5 to 10 times more likely to be affected. Patients who sustain hand injuries are at risk of experiencing temporary or permanent loss of hand function, severely impacting activities of daily living. Early treatment intervention can reduce the risk of long-term disability. The Wide Awake Local Anesthesia No Tourniquet (WALANT) technique, since its development, has revolutionized hand surgery with reported benefits. Our study aimed to analyze the scope of hand pathologies treated under WALANT and its associated failure rate and complications in our context. Materials and methods: We conducted a retrospective clinical audit of patients treated for hand pathology with WALANT at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) between 1 July and 31 December 2016. Demographic, pathology, and intraoperative data were collected from the hospital admissions, ward, and theater records of patients who met our inclusion criteria. Procedure waiting times and length of hospital stay were calculated from recorded dates and times. All collected data were de-identified and handled using REDCap (Vanderbilt University, Nashville, TN, USA) and Microsoft Excel version 16.51 (Microsoft Corp., Redmond, WA, USA) for storage and analysis. Descriptive statistics were employed, with measures of central tendency (mean, median, mode) and dispersion (standard deviation) calculated using the Data Analysis ToolPak in Microsoft Excel. Results: Data for 416 patients were included for analysis after all exclusions. The majority of patients were Black males. Employed individuals and the right hand were affected slightly more than the unemployed and the left hand, respectively. The fingers were affected slightly more than the hand (234 (22.6%); 163 (19.47%)), and infections (152 (36.54%)) were more frequently treated, followed by lacerations (131 (31.49%)). The average procedure waiting time and the length of hospital stay were significantly low, with an equally low complication (4/416 (0.96%)) and failure rate (91/416 (22.12%)). Conclusions: The practical advantages and clinical safety of WALANT in the South African context provide valuable insights into its role in enhancing healthcare delivery in LMICs. Our study demonstrated a high success rate, minimal complications, and significant cost-effectiveness in a broad scope of hand pathologies treated surgically under WALANT. This study contributes to the growing body of evidence supporting WALANT as a viable solution for managing hand conditions in settings where traditional methods, such as the use of general anesthesia and the availability of a theater, are often limited by financial and logistical constraints.