Salisbury VA’s “awake” hand surgeries

A Salisbury VA surgeon recently performed the first ever "awake" carpal tunnel surgery at the Charlotte VA Health Care Center. Veterans now will be able to avoid operating room procedures, such as anesthesia, and coordinating a ride home. Instead, they're in and out in under 30 minutes.

"It's been a tremendous help for our patients," said Dr. Jeffrey Baker, Salisbury VA section chief of Orthopedic Surgery. "Once you give the patient the option to do the procedure wide awake, they are quick to choose it. They've been coming up here to Salisbury VA to get it done but opening this up in Charlotte will allow us to treat the patients who don't want to drive to Salisbury."

"Revolutionary thing we're doing."

Baker, who will operate out of Charlotte one day per month, performed five cases on his opening day in Charlotte. Seven were scheduled with two no shows. He anticipates doing ten each morning going forward.

With more than a third of surgical referrals coming from the Charlotte area, demand for these procedures should remain consistent.

"Since we began doing these, I would guess we've done more than any VA in the country," Baker said. "It really is a revolutionary thing that we're doing."

Baker has simplified things and made it a "band aid surgery," and at 10-15 minutes per procedure, he can help a high number of Veterans.

"It's a very quick procedure," he added. "That's because we've stripped away all the operating room procedures. It takes time and additional staff to accommodate OR patients. I can do three or four of these procedures in the time it would take to do one such surgery in the OR."

Procedure takes less than 10 minutes

The surgeries help Veterans with issues such as carpal tunnel, trigger finger and ganglion cysts. A local anesthetic injection is given and a small incision is then made over the affected area. The surgeon then goes in to either fix the problem or remove the cysts. In many cases, the procedure takes less than 10 minutes.

Gone are the days of splinting and bracing of the repaired hand. Patients leave with a band aid and get things moving quickly. They tend to progress very well - a far cry from just several years ago.

"A friend had a carpal tunnel surgery done five years ago and you would have thought she'd had a total knee replacement," said Salisbury VA chief of staff Dr. Randall Gehle. "It was so uncomfortable for her that she canceled the opposite hand which was just as symptomatic because she didn't want to go through that again."

Thankfully, hand surgeries have come a long way. And bringing them to Charlotte is another way that Salisbury VA is improving patient access.

"We're going to do whatever we can to improve access to care, whether that's streamlining a procedure or bringing the care to another facility like we're doing in Charlotte," said Salisbury VA director Joseph Vaughn.

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