New concepts in hand surgery

What is wide-awake hand surgery?

Wide awake hand surgery refers to performing surgery on the hand using local anaesthesia only without the use of a tourniquet. It is abbreviated to WALANT in the medical literature (Wide Awake Local Anaesthesia No Tourniquet).

What conditions can be treated this way?

Many specific hand conditions both traumatic and chronic such as flexor and extensor tendon repair, trigger finger and carpal tunnel release, tenolysis, Dupuytren’s disease, tendon transfer and phalangeal fractures.

What are the advantages of WALANT?

There are many advantages to using WALANT. For example, there is no need for general anaesthesia or sedation. The patient can safely go home after their surgery. The procedure is carried out like a minor surgical operation with the patient being fully awake and cooperative. This is extremely advantageous when performing surgery such as tendon transfer or tenolysis, when full active movement of the joint needs to be determined.

What are the disadvantages of WALANT?

WALANT is not suitable for everyone. The injection of local anaesthesia can be slightly uncomfortable for the first 10 to 15 seconds much like a “bee sting”. It is the same feeling as a dental injection. Additionally, some patients may not like the feeling of being awake during their procedure.

 What should I do if I need surgery on my Hand?

At 152 Harley Street, our expert team of hand surgeons will assess your suitability for the WALANT procedure and advise you accordingly. We look forward to welcoming you soon.


Acne Scarring

Acne scarring can have a huge negative psychological impact on its sufferers and is the result of acne, which can appear at the same time or months after the acne has settled and treated. There are various types of acne scarring which can be easily divided into atrophic (loss of tissue) or hypertrophic/keloid (excessive thickened tissue).

The majority of acne scars on the face are atrophic which can be further subdivided into: rolling, icepick, and boxcar scars.


Icepick scars tend to be narrow and deep and are best treated with punch excision. This is a technique where the individual scar is completely removed surgically and the resultant shallow scar is much more amenable to laser treatment afterwards.


Boxcar scars tend to be less deep with shoulders and often rectangular or round shaped. These scars often respond well to laser resurfacing with CO2.


Rolling scars tend to have the appearance of hills and valleys and can appear with shadows and can vary in severity. Treatment often includes an initial procedure called subcision where the scarred tissue underneath is cut, allowing for release of the tethered scarring. Subsequently laser resurfacing is used for optimal results. At times, injection with dermal fillers can help too.


In terms of looks, the hypertrophic scar is usually red in colour and slightly elevated. They can become quite itchy or, in some instances, even painful. Hypertrophic scars are caused by injury, as with most scars. Common injuries or occurrences that may result in hypertrophic scars are body piercings, burns, cuts or after severe acne.

At 152 Harley Street, our Consultant Dermatologists offer a comprehensive tailor-made individual treatment which can constitute of any (or combination) of the aforementioned treatments. For example if you suffer from both rolling and icepick scars you will be treated with subcision for your rolling scars, followed by punch excision for your icepick scars and finally for the ultimate results with the CO 2 laser.