A protocol for wide awake local anaesthetic no tourniquet (WALANT) hand surgery in the context of the coronavirus disease 2019 (COVID-19) pandemic.

There are new and unique challenges to emergency surgery service provision posed by the Coronavirus disease 2019 global pandemic. It is in the best interests of patients for care providers to streamline services where possible to maximise the number of cases that can be performed by limited surgical and anaesthetic teams, as well as minimising patient interactions and admission times to reduce potential spread of the virus. There is evidence that wide awake local anaesthetic no tourniquet (WALANT) hand and upper limb surgery can meet this need in a number of ways, including reduced pre-operative work up, the lack of a need for an anaesthetist or ventilator, shorter inpatient stays and improved cost efficiencies.

The "Needle-splint" Technique: A Method of Accurate Apposition and Eversion during Microvascular Anastomosis.

We present the "needle-splint" technique, a microsurgical suturing technique that enhances micro-suturing technique, while ensures finer apposition and vessels walls eversion during the placement of sutures in microvascular anastomosis. This report demonstrates the usefulness of this technique in simple interrupted, continuous-interrupted, or multi-loops microsurgical suturing. It further allows direct visualization of the intra-wall-edges space and intimal sutures surface and could be utilized as a safety stabilizer to errors as it allows optimal vessels alignment while the needle curvature is acting as a "pusher" to separate the posterior wall during knot tying.