The effect of combined WALANT and Tranexamic Acid (TXA) application on postoperative bleeding and complications in CMC arthroplasty: A comparative study

Title : The effect of combined WALANT and Tranexamic Acid (TXA) application on postoperative bleeding and complications in CMC arthroplasty: A comparative study

Abstract:

Background: Wide Awake Local Anesthesia No Tourniquet (WALANT) has become a preferred anesthetic approach in hand surgery due to its benefits in reducing costs, avoiding systemic anesthetics, and enhancing intraoperative patient communication. Tranexamic Acid (TXA), a potent antifibrinolytic agent, is commonly used to minimize surgical bleeding. This study hypothesizes that the combined use of WALANT and TXA in carpometacarpal (CMC) arthroplasty reduces postoperative bleeding and complications compared to WALANT alone.

Methods: A prospective, randomized controlled study was conducted on 12 patients undergoing trapezectomy and ligament reposition arthroplasty for thumb cmc arthritis. Patients were divided into two groups: Group A (n=6) received WALANT alone, while Group B (n=6) received WALANT combined with intraoperative TXA (topical and/or intravenous). Intraoperative bleeding was assessed via visual blood loss estimation, and postoperative bleeding was evaluated using drain output (if applicable) and wound site hematoma incidence. Complication rates, including infection, delayed wound healing, and thromboembolic events, were recorded at 2, 6, and 12 weeks postoperatively.

Results: Preliminary findings indicate a significant reduction in intraoperative blood loss (p<0.05) and postoperative hematoma formation in Group B compared to Group A. Additionally, Group B demonstrated lower overall complication rates, particularly regarding delayed wound healing and infection. No thromboembolic events were reported in either group.

Conclusion: The combined use of WALANT and TXA in CMC arthroplasty appears to reduce postoperative bleeding and complications without increasing thromboembolic risk. This dual approach may offer a safe and effective alternative for optimizing surgical outcomes in hand surgery.

Keywords: WALANT, Tranexamic Acid, thumb cmc arthritis, Postoperative Bleeding, Hand Surgery, Complications

Biography:

Fatih Yuvaci after receiving his medical degree in 2015, Dr. Yuvacı completed his Trauma and Orthopaedics residency training programme in 2021 and received the title of Trauma and Orthopaedic Specialist. He took part in academic research studies and took an active role in oral presentations at various congresses. In 2024, he joined the Hand Surgery Fellowship program at Istanbul University Faculty of Medicine and continues to work actively in the hand surgery department.