Background: Hand surgery is increasingly transitioning from hospital operating theatres to outpatient settings, requiring anaesthetic methods that are efficient, cost-effective, and patient-centred. Traditional anaesthesia, such as general anaesthesia, poses challenges including prolonged recovery and physiological stress. Novel strategies, such as Wide-Awake Local Anaesthesia No Tourniquet (WALANT), ultrasound-guided distal nerve blocks, and adjunctive approaches (vapocoolant spray, patient-controlled regional analgesia, cryoanalgesia, jet injectors), have emerged to address these limitations. This narrative review consolidates current evidence regarding the efficacy, applicability, and economic implications of these evolving anaesthesia techniques. Methods: A literature search was conducted across MEDLINE, Embase, CENTRAL, and Scopus databases up to 1 June 2025. Inclusion criteria were English-language original studies on WALANT, vapocoolant sprays, ultrasound-guided distal nerve blocks, or emerging adjunctive anaesthesia methods applicable to hand and upper limb surgery. Exclusion criteria included non-English publications and those without original clinical data. Two independent reviewers screened and selected studies, ensuring relevance and methodological quality. Results: WALANT can provide high patient satisfaction, cost savings of 70–85%, and allow for real-time functional testing during surgery. Ultrasound-guided nerve blocks provided targeted analgesia, preserved elbow function, reduced the need for sedation, and improved perioperative efficiency. Adjuncts such as vapocoolant sprays significantly decreased needle-injection discomfort, offering quick and economical analgesia for superficial procedures. Other emerging adjuncts, including patient-controlled regional anaesthesia (PCRA), cryoanalgesia, and jet injectors, offered additional patient-tailored pain management options, although with higher resource demands. Conclusions: The review highlights the transformative potential of WALANT and adjunctive techniques to enhance efficiency, patient experience, and cost-effectiveness in hand surgery. Despite clear benefits, optimal application requires tailored patient selection, clinician familiarity, and consideration of procedure-specific demands.

Background: Painful digital neuromas are disorganized nerve proliferations that develop following traumatic or iatrogenic digital nerve injury, often resulting in debilitating allodynia, hypersensitivity, and impaired hand function. While conservative therapies such as desensitization, splinting, and pharmacological agents may offer temporary relief, over 50% of patients ultimately require surgical intervention. However, surgical strategies remain highly heterogeneous, and no consensus exists regarding the most effective operative technique. Methods: A comprehensive search of 4 databases through May 2025 identified 30 studies encompassing over 600 adult patients who underwent surgical treatment for digital neuromas. Techniques assessed included neuroma excision with nerve stump transposition, direct end-to-end neurorrhaphy, nerve capping, regenerative peripheral nerve interface (RPNI) surgery, and targeted muscle reinnervation (TMR) surgery. Results: Excision with transposition relieved pain in up to 80% of cases but demonstrated inconsistent sensory recovery. Neurorrhaphy was associated with superior functional outcomes and a reduced recurrence rate. Nerve capping and polyglycolic acid-collagen conduits significantly improved pain scores and protective sensation. RPNI and TMR surgery, though reported in small series, provided over 80% pain relief with minimal complications. Meta-analysis was precluded by outcome heterogeneity. Conclusion: Surgical treatment of painful digital neuromas provides meaningful pain relief and functional improvement, particularly when techniques restore physiologic targets for regenerating axons rather than relying on excision alone. Continuity-restoring and reinnervation-based approaches, including neurorrhaphy, nerve capping, RPNI, and TMR, demonstrate favourable outcomes with lower recurrence rates, although comparative evidence remains limited. Standardised outcome measures and higher-quality comparative studies are required to guide optimal, patient-specific surgical decision-making.

Background: Abdominal bulge after deep inferior epigastric perforator (DIEP) flap breast reconstruction is an uncommon but clinically meaningful donor-site complication. Although several operative repair strategies have been described, evidence guiding management remains limited. Methods: This review was prospectively registered (PROSPERO CRD420261368586). MEDLINE, Scopus, and Web of Science were searched from inception to August 2026 for studies reporting abdominal wall morbidity after DIEP flap breast reconstruction and describing management of an established complication with extractable outcomes. Quality was appraised with Joanna Briggs Institute tools and certainty of evidence with GRADE. Heterogeneity in design, definitions, techniques, and outcome reporting precluded meta-analysis, so findings were synthesized narratively. Results: Six studies were included: five retrospective single-arm series and one case report, with no randomized, prospective comparative or controlled study identified. Clinically relevant bulge or hernia occurred in 3.6% to 4.8% of patients in cohorts reporting denominators. Repair outcomes were extractable for 34 patients across five studies, spanning DIEP-specific and mixed abdominal free-flap populations. Reported techniques were open fascial plication with onlay mesh, laparoscopic underlay, robotic retromuscular, and enhanced-view totally extraperitoneal repair. Persistent or recurrent deformity followed both open and minimally invasive approaches. Certainty was very low for every outcome assessed, and no study used a validated post-repair patient-reported outcome measure, objective abdominal wall function testing, or imaging-confirmed durability assessment. Conclusions: Operative management of post-DIEP abdominal bulge is poorly standardized, and very low certainty evidence does not establish superiority of any technique, mesh type, or mesh plane. We propose a phenotype-based classification, a structured assessment pathway, and a minimum reporting dataset for secondary repair, offered as expert interpretation requiring prospective validation rather than as guidance. Future studies should use standardized phenotyping, repair-specific follow-up, cross-sectional or dynamic imaging, objective function testing, and validated patient-reported outcomes.

Background and Objectives: Dupuytren’s disease (DD) most commonly affects the palm and metacarpophalangeal/proximal interphalangeal joints; distal digital involvement at the distal interphalangeal joint (DIPJ) is uncommon and incompletely characterised. This systematic review summarises reported cases of DD involving the DIPJ, with or without proximal interphalangeal joint (PIPJ) involvement, focusing on clinical patterns, management, and reported outcomes. Materials and Methods: A systematic search of PubMed, Embase, and Scopus from database inception to July 2025 identified published case reports and case series describing DD confined to the DIPJ ± PIPJ of a single digit. Data were extracted on the demographics, digit involvement, anatomic features when reported, interventions, outcomes, complications, recurrence, and follow-up. Results: Nine studies reported 13 patients, published between 1991 and 2023. All patients were male (age range 25–79 years). The little finger predominated (10/13), followed by the ring (2/13) and index finger (1/13). When laterality was described, radial-sided distal cords were common. Surgical fasciectomy was performed in 11 cases and collagenase clostridium histolyticum (CCH) in 2 cases. Where postoperative correction was reported, outcomes were generally favourable; however, joint-specific range-of-motion outcomes and follow-up were inconsistently documented. Follow-up, when reported, ranged from 3 months to 3 years. One recurrence involving the PIPJ was reported 36 months after surgical management. No intraoperative neurovascular or tendon injuries were described, although adverse-event reporting was incomplete in some reports. Conclusions: Reported cases of DD involving the DIPJ most frequently involve the little finger in men. However, the available evidence is limited to a small number of selectively published case reports and series with incomplete outcome and follow-up reporting. These observations should therefore be interpreted cautiously, and comparative effectiveness or durability estimates cannot be established.