2026 TSHT Webinar - WALANT Beyond the Hand: Expanding Frontiers to Nerve Transfers and Spasticity Reconstruction

This advanced masterclass explores the massive structural paradigm shift of Wide-Awake Local Anesthesia No Tourniquet (WALANT) as it expands outwards from basic hand procedures into highly complex, proximal upper extremity reconstructions. Participants will comprehensively analyze the required clinical synergies between hand therapist and surgeon, evaluate the intricate methodologies of real-time intraoperative motor mapping, and master custom post-surgical specialized accelerated movement timelines.

Date: November 21, 2026 8:30am CST

Format: Live Zoom meeting

Presenter: Dr. J. Terrence Jose Jerome MBBS, FRCS (Glasg), DNB (Orthopaedics), FNB (Hand & Microsurgery), European Diploma in Hand Surgery, FICS, PGDMLE

Dr. J. Terrence Jose Jerome is a world-renowned pioneer in wide-awake upper limb surgery and complex peripheral nerve reconstruction. Serving as the Consultant and Department Head at the Olympia Hospital & Research Centre, he also holds an academic appointment as Associate Professor of Orthopaedics & Traumatology at Dhanalakshmi Srinivasan Medical College Hospital. Over an illustrious career spanning more than 18 years as the Editor-in-Chief of the prestigious Journal of Hand and Microsurgery, he has authored over 250 high-impact scientific publications. Dr. Jerome was recently awarded the celebrated **2026 PRS Global Open Best Paper Award – Hand** for his revolutionary research regarding wide-awake brachial plexus nerve reconstructions, making him an internationally distinguished voice on expanding the limits of safe outpatient micro-surgery.

Webinar Outline:

1. Introduction & The Evolution of WALANT (10 Minutes)

The WALANT Paradigm Shift: Reviewing the underlying chemical mechanics of high-volume tumescent local anesthesia using structured lidocaine and epinephrine to completely bypass regional arm tourniquets or sedation lines safely.
Moving Up the Arm: Transitioning the reliable physiological properties of wide-awake surgical access from isolated finger fields to complex proximal fields, expanding reconstruction options across major structures.
The Therapist-Surgeon Synergy: Emphasizing the vital, non-negotiable team communication dynamic necessary from original patient clinical enrollment up through definitive hand rehabilitation cycles to maximize actual overall outcomes.

2. Frontiers in Nerve Transfers Under WALANT (20 Minutes)

Surgical Overview: Analyzing practical methods for performing deep, proximal targeted motor nerve transfers (such as AION to ulnar motor branch or spinal accessory to suprascapular nerve conversions) with a fully alert patient.
Intraoperative Motor Mapping & Validation: Harnessing the conscious individual's direct voluntary cortical drive to mapping out nerve recruitment paths and visually validating structure alignment, bundle redirect pathways, and accurate physical connection tension in real time.
Therapy Implications & Early Activation: Eradicating cognitive latency fields by allowing the alert patient to instantly visual-feel contractions in the OR, triggering immediate cortical remodeling paths, reducing donor trace patterns, and safely optimizing Early Active Motion (EAM) protocols.

3. Spasticity Reconstruction Beyond the Hand (20 Minutes)

Surgical Overview: Addressing specialized upper motor neuron dysfunctions caused by stroke, traumatic brain injury (TBI), and spinal cord injury (SCI) through precise hyperselective neurectomies, structural tendon lengthening, and fractional transfers.
The Power of Awake Tone Assessment: Bypassing the deep paralysis masks caused by traditional general anesthesia (flaccid muscles) to systematically evaluate exact patient spasticity levels under direct active instruction to target, relax, or resist real-time positional changes.