A Hand Surgery Service For Everyone...
A Private Hand Surgery Service...
in a prestigious Central London Setting...
available for NHS patients
This Website is concerned with the One Stop Wide Awake (OSWA)
Orthopaedic Hand Surgery Service
For OSWA patients and colleagues wishing to understand the
OSWA patient pathway please read on
OSWA depends upon the wide awake approach to hand surgery
If you wish to understand the basic principles of wide awake hand
surgery you may find The Worldwide Awake Hand Surgery Group
OSWA represents the progression of wide awake hand surgery...
WIDE AWAKE HAND SURGERY
in Fitzrovia, CENTRAL LONDON
, United Kingdom
under local anaesthesia
ONE STOP WIDE AWAKE
A private Hand Surgery Service for everyone...
Private wide awake hand surgery service in London.
Welcome to the ONE STOP WIDE AWAKE website which aims to
enable orthopaedic and hand surgeons and hence their patients
to benefit from our large UK experience of
Wide Awake Hand Surgery
and Wide Awake Dupuytren's Fasciectomy
- which has been
and indeed by patients and eminent colleagues...
" Dear Dr Bismil...
I congratulate you on your paper
and I completely endorse everthing you have in it."
Mr TH ROBBINS- pioneer of Wide Awake Hand Surgery in Australia
*** FOR HAND SURGEONS SEEKING ADVICE AND GUIDANCE IN THEIR TRANSITION TO WIDE AWAKE HAND SURGERY
PLEASED TO ANNOUNCE THAT THE
WORLDWIDE AWAKE HAND SURGERY GROUP
WILL SUPPORT YOUR TRANSITION TO WIDE AWAKE HAND SURGERY ***
- The Worldwide Awake Hand Surgery group
based at BMI Fitzroy Square-
aiming to offer best advice for any hand surgeon transitioning to OSWA care...
search "hand surgery awake" or "worldwide awake" or "worldwide awake hand surgery group"
The New Website for Worldwide Awake Hand Surgery group is here
For all queries please e-mail group secretary Mr Quamar Bismil at:
Specialist Consultant Orthopaedic Surgeons
in Wide Awake Fasciectomy
Specialist Orthopaedic Soft-tissue, Hand and Upper Limb Surgery
now in London:
performed purely under Local Anaesthesia (wide awake);
with no tourniquet, sedation, general or regional anaesthetic;
and with the option of the entirety of management bein performed in
one management stop...
Specialists in Wide Awake Dupuytren's Fasciectomy
(first large volume UK published experience)...
Developed with and for NHS Patients
by MSK and QMK Bismil
Consultant Orthopaedic Surgeons
SCIENTIFIC ARTICLES PUBLISHED BY THE ROYAL SOCIETY OF MEDICINE, LONDON
PLEASE CLICK ON THE PAPERS BELOW TO READ
Welcome to the website of The One Stop Wide Awake Hand Surgery service, which has been specialising in One Stop Wide Awake orthopaedic hand surgery under local anesthetic for over a decade; and aims to enable hand and orthopaedic upper limb orthopaedic surgeons to achieve excellence in one stop wide awake orthopaedic and hand surgical care under local anaesthetic.
OUR AIMS, PRINCIPLES AND OBJECTIVES:
1. To deliver convenient, effective and lower risk orthopaedic wide awake care across London
2. To utilize our clinical experience to deliver optimal wide awake hand surgery for nhs patients via Choose and Book
3. To utiltize our research and audit experience to deliver ubiquitously safe and effective wide awake care
4. To enable nhs and private patients alike to experience totally-patient-centered care
5. To work with our hand therapy colleagues to continually optimise outcomes
6. To advance wide awake hand surgery in the UK through open access scientific publication
7. To work with ambulatory care organisations in the UK such as the British Association of Day Surgery and the SWAG group to optimize the evidence-based one stop pathways
8. To provide unparalleled levels of totally Consultant-delivered care throughout the patient journey
9. To ensure every patient knows their Consultant is always only a phonecall or e-mail away (we will barring acts of God respond to every patient query on an immediate/urgent basis).
10. To deliver our service for patients of BMI Healthcare in our unique period setting: BMI Fitzroy Square...
The UK-based OSWA service has been recognised in its contribution to the advancement of lower risk Dupuytren's surgery under local anaesthetic:
Our Consultant Surgeons Specialise in One STOP Wide Awake hand surgery and Soft Tissue Orthopaedic Problems including Dupuytren's Contracture.
Images reproduced from the original UK wide awake fasciectomy paper
To us, OSWA epitomises patient-centred, efficient and cost-effective care in the 21st century. Now that the original OSWA service has received the aforementioned recognition through peer-reviewed scientific publication we expect that our model will be replicated worldwide. Recognition by the RSM in London in 2012 was a big step in the globalisation of OSWA from our UK base; but to all of the OSWA team what is most important are our OSWA patients, and perhaps the best way to introduce the OSWA concept is through one of our many satisfied patients...
Mr DR 2011 OSWA Dupuytren's Contracture Hand Surgery Patient
IN THE ENTIRETY OF HIS OWN WORDS with his kind cooperation and consent...
This is a verbatim transcription of Mr R's story with no editing...
"The small lump in the middle of the palm of my left hand directly below the middle finger was starting to become annoying although not painful. If you caught it in just the right position the whole hand would close up, a bit like a venus fly trap, and the only way to open all the fingers up was to use the other hand. As this usually seemed to happen when I was changing gear whilst driving I thought I should get it seen to.
Initially my local GP was not sure exactly what it was, and eventually after referral to the Orthopaedic Hand Surgery Department at my local hospital it was established that it was a Dupuytren’s Contraction which the consultant decided he would remove as a day surgical case.
It was at this point that it starts to get interesting as the Primary Care Trust was not prepared to fund the procedure at the hospital but wanted it done via the Primary Care Surgical Service which is how I found myself in Boston one June afternoon and got introduced to the world of OSWA.
Now there is an acronym to play with OSWA or more precisely One Stop Wide Awake surgery or should that be OSWAS? But it is an acronym that I expect we are all going to become more familiar with over the years.
What exactly does it mean? Well it is as they say what it says on the tin, One Stop and yes you are Wide Awake.
Basically you turn up for your appointment are seen by the consultant, and after a brief explanation of what needs doing you find yourself 5 minutes later in the operating theatre. The worst bit is the injection, similar to the dentist really – they don’t seem to have found a way of sticking a needle into you without it hurting a bit but in a few seconds the anaesthetic kicks in and your hand loses all sensation. It is at this point you realise they really do mean Wide Awake as the trays of instruments come out and they start the procedure.
How long they play around is going to depend on how severe the Dupuytren’s is but if it is caught early you are going to find yourself back on the street within half an hour wondering quite what all the fuss was about.
Okay, you are going to have your hand bandaged up with a pad the size of a cricket ball, so don’t wear anything with tight sleeves, and your arm will be in a sling but it really is that straightforward.
Now you do need to do a bit of planning because if you have the procedure in the afternoon the local anaesthetic will probably not have worn off completely by the time you go to bed. If, however, you have the procedure done in the morning then the anaesthetic will probably wear off around tea time. So you are probably going to need some pain killers for the first 24 hours or so but it is more a question of discomfort rather than pain.
After 3 or 4 days you can remove the dressing and inspect the consultants’ handiwork which will just be a neat row of stitches, and then a few days later off to the GPs to get the stitches removed.
Of course it is not really that simple, you do have to keep the hand dry, which can be a challenge. In the end I became quite expert at wrapping the hand in cling film but then I am right handed.
Within a few weeks the hand was back to normal and you needed a magnifying glass to see where the scar actually was.
So the rest of the summer passed quite uneventfully. By the autumn I realised that there were a few things that had not really been explained that well. It seems Dupuytren’s do not come in singles and even I, now an expert in this condition, could see that two more fingers were becoming affected so it was back to Boston.
This time I was a bit more blasé about the whole thing and opted for a late afternoon appointment, yes you really do get to choose, and took my wife for a bit of Christmas shopping before the appointment and an early dinner afterwards. Then once Christmas was out of the way it was back again in January for the third and hopefully final procedure.
So I have to admit that I am a convert to OSWA or is it OSWAS? I do not kid myself that it is all over yet. Most of the people I know with this condition seem to have it in both hands so my right hand may well yet cause a problem, and that will certainly be more inconvenient than the left hand was. But at least now I know where to go to get it sorted!"
Patients' experiences are the most important marker of what we do and are presented throughout the website. In order to
quickly scan for OSWA Hand Surgery patients' valuable feedback please look for the cartoon/animations throughout the
website. Any hand surgeon looking to transition to The Wide Awake Technique
can contact Mr Bismil at BMI Fitzroy Square.
Our Consultant Orthopaedic Surgeons specialise in one stop wide awake hand and upper limb orthopaedic surgery. The one stop wide awake hand surgery service has been offering the best possible care for patients with orthopaedic and hand surgery problems for well over a decade.
In 2011 the one stop wide awake orthopaedic upper limb and hand surgery service treated approximately one thousand hand surgery patients.
We are as far as we are aware the world's first totally one stop wide awake Dupuytren's service:
Dupuytren's Wide Awake Fasciectomy- The UK Experience
- circa 1980 TH Robbins a hand surgeon from Australia publishes his technique of straight incisions and deferred Z plasty
- For the next 30 years Mr MSK Bismil conducted hundreds of operations using this technique in the UK- intially under GA
- circa 2005 Denkler a hand surgeon from the US shows that wide awake fasciectomy is safe and effective in a case series
- circa 2009 Nelson and Lalonde hand surgeons from Canada publish a comparative study of Wide Awake versus GA fasciectomy demonstrating equivalence
- 2012 Bismil, Bismil and Bismil et al publish the UK experience of Wide Awake Fasciectomy using Robbins' technique of straight incisions +/- deferred Z-plasty. This wide awake technique centres on safety for the patient (wide awake) and the neurovascular bundle (straight incisions).
Hand surgeons worldwide are starting to move to the total wide awake care we provide.
We specialise in Wide Awake Hand Surgery...
The One Stop Wide Awake service specialises in the outpatient, same-day treatment of many common hand and upper limb orthopaedic conditions including: Dupuytren's contracture, carpal tunnel syndrome, ulnar nerve entrapment (wrist and elbow), ganglia, mucoid cysts, trigger finger and trigger thumb. Through OSWA all hand and upper limb conditions are seen and treated within a 30-45 minute management slot.
We treat all stages of Dupuytren's Contracture under local anaesthesia (Wide Awake fasciectomy) including revisions of surgery previously performed in hospital under GA. The following OSWA local anaesthetic Hand Surgery case demonstrates the six week result following hand surgery to correct this gentleman's ring finger under local anaesthesia which had previously been operated on under GA:
Images reproduced from the original UK wide awake fasciectomy paper
Audit, governance and research are paramount and enabled the transition to a total one stop wide awake hand surgery service as documented in the 2012 RSM London publications which detail the service evolution. The Lincolnshire OSWA service was pioneered by Mr MSK Bismil over a decade ago. In 2013 the London OSWA hand and upper limb surgery service will aim to bring the benefits of OSWA hand and Dupuytren's surgery to patients all over London. Our continuous audit processes have clearly documented efficiency, effectiveness and patient satisfaction for the OSWa approach to Hand Surgery.
Our absolute aims are clinical excellence and effective, efficient and patient-centred care in Hand and Upper Limb surgery under local anaesthesia.
The One Stop Wide Awake hand and upper limb surgery model is presently the focus of a great deal of interest. With the current and impending changes in UK healthcare provision (PCT to CCG etc) the one stop wide awake hand surgery model is likely to be adopted nationwide.
For commissioning queries in London please contact The BMi Fitzroy Square Hospital.
Through our OSWA hand surgery model we have eliminated surgical waiting lists; and preoperative and postoperative consultations- and all treatment is under local anaesthetic.
This website is designed to inform and educate patients of The One Stop Wide Awake hand surgical service; and aims to enable excellence in One Stop Wide Awake orthopaedic hand surgical care.
The above diagrams contrast the OSWA hand surgery approach with the traditional pathway. We have eliminated the need for: preoperative or anaesthetic assessments; multiple visits to see a hand or orthopaedic surgeon; routine clinic visits; surgical waiting lists; triage by a physiotherapist or other practitioner; general anaesthesia, regional anaesthesia or sedation; tourniquets; a hospital, recovery or ward bed. The traditional hand surgery pathway may involve between five and ten 'stops' (solid red circles on the above diagrams): The OSWA hand and wrist surgical pathway centres around complete wide-awake surgical care in ONE STOP hand surgery. Most patients spend less than an hour with us (including waiting time) and receive the complete surgical care they require, which via the traditional pathway would have taken several months to achieve.
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Thank you for visiting the OSWA Service website which aims to enable orthopaedic and hand surgeons to achieve excellence in modern hand and upper limb surgery under local anaesthesia. The OSWA hand surgery service was established in Lincolnshire for NHS patients and our aim is to provide the service in London by 2013. We hope to be able to provide tailored packages of OSWA specialist hand and upper limb surgical treatment to NHS, insured and self-pay patients in London and Lincolnshire. We are as far as we are aware the largest single provider of totally Wide Awake Dupuytren's Contracture surgery under Local Anaesthesia in England, UK or worldwide.
The OSWA hand surgery service was developed in Lincolnhire cira 1999. In 2013 and beyond we aim to provide our OSWA specialist hand surgical service in Central London. Our aim is to provide the service for all patients- and will strive to provide various OSWA packages of hand surgery for all patients in London and Lincolnshire. We hope local Primary Care Trusts and then clinical commissioning groups will enable us to replicate the OSWA Lincolnshire model in London. Also, insured and self-pay patients will have a variety of bespoke packages to choose from.