Implicit bias is an unconscious, automatic association that is either disadvantageous or favorable toward a person or group.A microaggression is an intentional or unintentional statement or action that is perceived as discriminatory against a marginalized community, emanating as the product of bias.Intersectionality is a concept that describes the exponential discrimination toward individuals who belong to more than one marginalized group, such as their racial and ethnic group and gender affiliation.Implicit bias and microaggressions that negatively affect marginalized groups are ubiquitous in medicine (including Hand Surgery), which contribute to health and health care disparities for patients, as well as poor representation and burnout of marginalized groups within the medical community.Although awareness is the first step to combating bias and microaggressions, active steps should be taken to minimize the negative effects of these phenomenon, starting with taking an implicit bias test to understand your own biases.Pediatric wide-awake local anesthesia no-tourniquet technique (WALANT) hand surgery is feasible for the treatment of the spectrum of pediatric hand surgeries, which can include traumatic injuries and congenital hand differences.

The key component for success is identifying the appropriate patient for this technique, with the typical patient frequently being >10 years of age. The discussion with the patient and adequate preparation for maximum efficiency become key for patient and surgeon comfort. Here we describe a practical approach for successfully performing this valuable technique for the pediatric population.Pediatric hand injuries are common and can require operative intervention. General anesthesia is frequently required for hand and upper-extremity surgery; however, having the patient completely awake during the procedure can provide several benefits. Wide-awake local anesthesia no-tourniquet technique (WALANT) hand surgery has been established as a reasonable means in the adult population for surgeries that include trigger finger release, open carpal tunnel release, tendon surgery, and more complex reconstruction. In this technique, no additional medications are administered besides local anesthesia. No tourniquet is used, given that prolonged use results in extremity discomfort and pain.

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Mishita
Jornal co-ordinator
Journal of General Surgery Reports