The wide-awake hand surgery (WAHS) technique involves injecting lidocaine with adrenaline for hand surgical procedures that are done without the use of tourniquets, sedation, regional or general anaesthetic. This is a retrospective review of the first 100 consecutive patients who underwent operations using this technique at our centre. The operations included carpal and cubital tunnel decompression, trapeziectomy, tendon transfer, and tenolysis. A questionnaire adapted from Lalonde's previous work on wide-awake surgery was used to assess patients' experiences. Sixty-five percent of the patients responded to the postal questionnaire, the majority reporting a high satisfaction level. Ninety-one percent of responders reported that the operation was less painful or comparable with a procedure at the dentist; 86% would prefer to be wide-awake if they needed to have hand surgery again, and 90% stated they would recommend WAHS to a friend.

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In this study, the authors aim to quantify the impact of COVID-19 on burns provision at an adult regional burn centre. Two cohorts of patients were identified for comparison: one during the beginning of the COVID-19 lockdown in April 2020 and a comparator cohort in April 2019. There was a 30% decrease in the incidence of adult burns in 2020. The mean total body surface area (TBSA) was 1.8% and 4.3% in 2019 and 2020, respectively. Scald injuries were the commonest mechanism of burns in both cohorts. Depth of burns were deeper in 2019, with 17.6% of patients presenting with deep burns, compared with 9.6% in 2020. 8% of patients in 2019 required theatre compared with zero patients in 2020. A similar percentage of patients were admitted in both cohorts. In 2019, admitted patients had an average inpatient stay of 0.57 days per TBSA. In 2020, the average stay per TBSA in all patients was 0.6 days and 1.5 days in survivors. In the lockdown period, 54% of patients were followed up by telemedicine. This difficult period has taught us how important a functioning healthcare system is and how we can be better prepared in the future.

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During the onslaught of the SARS-Cov-2 (COVID-19) pandemic, majority of healthcare systems focused their approach towards disease containment. The main strategies involved measures to prevent disease spread through social distancing; shielding and use of personal protective equipment (PPE); testing and quarantine of infected cases; and rationalising health care [ 1 2 _ T D $ D I F F ] services to prioritise intensive care (ICU) resources.These measures have had a significant impact on Burns services worldwide. Instigating infection control measures to protect Burn and non-Burn injured patients as well as healthcare staff, create complex logistical arrangements considering the potential risks of transmitting COVID-19 whilst delivering care on the ward and in theatres amidst shortages of PPE [1,2]. There is a reliance on planning discharge of care and patient isolation (suspected or proven COVID-19 = RED area; unsuspected COVID-19 = GREEN area) based on the outcome of the patients' test [3]; particularly oro-and nasopharyngeal (ONP) RT-PCR swabs despite uncertainties on the validity of the results.

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