Wide Awake Plastic Surgery: Principles, Indications, Limitations and Future Directions
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What changes when the patient stays awake? Dr. Don Lalonde presents a practical, evidence-based approach to WALANT and field sterility, illustrated by real cases ranging from forehead and groin flaps to skin grafts, breast surgery, trauma procedures, amputations, and hand surgery.
The lecture goes beyond the idea of simply avoiding general anesthesia. It explores how careful tumescent injection can make local anesthesia almost painless, why many procedures can be performed outside the main operating room, and how an awake patient can actively contribute to surgical safety. Particular attention is given to flexor tendon repair, including intraoperative active testing, six-strand M-Tang repair, and judicious pulley venting.
The final discussion adds practical details on injection technique, local anesthetic dosing, patient selection, contraindications, antibiotics, and combining WALANT with regional anesthesia. For surgeons working with limited operating-room or anesthesia resources, the examples offer plenty to reconsider.
The lecture goes beyond the idea of simply avoiding general anesthesia. It explores how careful tumescent injection can make local anesthesia almost painless, why many procedures can be performed outside the main operating room, and how an awake patient can actively contribute to surgical safety. Particular attention is given to flexor tendon repair, including intraoperative active testing, six-strand M-Tang repair, and judicious pulley venting.
The final discussion adds practical details on injection technique, local anesthetic dosing, patient selection, contraindications, antibiotics, and combining WALANT with regional anesthesia. For surgeons working with limited operating-room or anesthesia resources, the examples offer plenty to reconsider.
EDU-LECTURES
Course
Educational Lectures
01
1:29:40 Now playing
Wide Awake Plastic Surgery: Principles, Indications, Limitations and Future DirectionsDr. Don Lalonde challenges traditional assumptions about anesthesia and operating-room sterility, showing how WALANT can make a wide range of procedures simpler, safer, and more accessible.
02
1:15:25
Primary Reconstruction of Open Hand Injuries in Children: Principles and TacticsA practical lecture on primary reconstruction of pediatric hand injuries, with a focus on local and regional flaps, preservation of finger length and function, and strategies to reduce contracture risk.
03
46:23
“When a Scalpel Is Not Enough: The Role of Lasers in Modern Plastic Surgery” Can lasers change the outcome when repeat surgery is no longer the best option?How laser therapy can be used to modify scar texture, pigmentation and vascular components, and why treatment should begin with identifying the right tissue target rather than choosing a laser first.
04
38:37
Back to basic or what we Didn`t know about Radiation Fibrosis?A back-to-basics look at radiation fibrosis: from inflammation and TGF-β signaling to fibroblast activation, extracellular matrix accumulation, hypoxia, and impaired matrix turnover. The lecture also explores how changes in radiotherapy fractionation may influence late tissue damage.
05
1:03:36
Post-Traumatic Lymphedema - Comprehensive Approach and Microsurgical TreatmentHow reconstructive surgery can restore not only soft tissue, but also lymphatic flow after limb trauma.
06
1:09:12
Limb Salvage vs AmputationA practical discussion of one of the hardest decisions in severe limb trauma: when reconstruction offers a realistic path to function, and when amputation becomes the better strategic choice.
07
1:38:09
Amputation or Limb Salvage in Combat Trauma: Surgical Decision-MakingA case-driven lecture on one of the hardest decisions in combat trauma: when reconstruction still serves the patient — and when amputation may offer the better functional path.
08
39:23
Bony Reconstruction for Sarcoma and OsteosarcomaA case-based lecture on vascularized fibula and iliac bone reconstruction after oncologic resection, with practical guidance on flap selection, fixation, monitoring and multidisciplinary planning.
09
40:21
Reconstruction of Large Bone Defects: From Debridement to Masquelet and Bone TransportLlewellyn Thomas explores a practical orthoplastic approach to complex bone defects after trauma, infection and oncologic resection—from radical debridement and limb-salvage decisions to bone transport, the Masquelet technique and alternative reconstructive options.
Wide Awake Plastic Surgery: Principles, Indications, Limitations and Future Directions