{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T23:56:52Z","timestamp":1781135812568,"version":"3.54.1"},"reference-count":11,"publisher":"Georg Thieme Verlag KG","issue":"03","license":[{"start":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T00:00:00Z","timestamp":1765411200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Handchir Mikrochir Plast Chir"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>WALANT (Wide Awake Local Anaesthesia No Tourniquet) has revolutionised hand\n                  surgery by enabling procedures with a combination of lidocaine and epinephrine,\n                  thereby eliminating the need for sedation or a tourniquet. Although epinephrine is\n                  now considered safe in low concentrations, rare ischaemic complications may still\n                  occur.<\/jats:p>\n                  <jats:p>This report concerns a 74-year-old woman who developed delayed-onset digital\n                  ischaemia after WALANT-assisted excision of a Dupuytren\u2019s nodule. Phentolamine,\n                  the standard reversal agent, was unavailable. Local infiltration with urapidil\n                  (12.5\u2009mg), a selective \u03b1\u2081-adrenergic antagonist, rapidly restored perfusion and\n                  sensation. The patient recovered fully without sequelae.<\/jats:p>\n                  <jats:p>This case highlights a rare but critical complication of WALANT. Urapidil may\n                  represent a safe and effective alternative to phentolamine in the management of\n                  epinephrine-induced vasospasm.<\/jats:p>","DOI":"10.1055\/a-2739-3810","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:15Z","timestamp":1765497615000},"page":"273-276","source":"Crossref","is-referenced-by-count":1,"title":["Late-Onset Digital Ischaemia after WALANT: Successful Reversal\n               with Off-Label Urapidil"],"prefix":"10.1055","volume":"58","author":[{"given":"Andrea","family":"Frey","sequence":"additional","affiliation":[{"name":"Hand Surgery, Kantonsspital Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Mathys","sequence":"additional","affiliation":[{"name":"Hand Surgery, Kantonsspital Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Kammerhofer","sequence":"additional","affiliation":[{"name":"Hand Surgery, Kantonsspital Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,12,11]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"A81","DOI":"10.1186\/1753-6561-9-S3-A81","article-title":"Wide awake local anaesthesia no tourniquet technique (WALANT)","volume":"9","author":"D Lalonde","year":"2015","journal-title":"BMC Proc"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1097\/00006534-200107000-00017","article-title":"A comprehensive review of epinephrine in the finger: to do or not to do","volume":"108","author":"K Denkler","year":"2001","journal-title":"Plast Reconstr Surg"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1007\/s11552-015-9759-6","article-title":"Achieving the optimal epinephrine effect in wide awake hand surgery","volume":"10","author":"D E McKee","year":"2015","journal-title":"Hand (N Y)"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1530\/EOR-24-0033","article-title":"WALANT surgery of the hand: state of the art","volume":"9","author":"I Degreef","year":"2024","journal-title":"EFORT Open Rev"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1177\/229255030301100408","article-title":"How long does it take phentolamine to reverse adrenaline-induced\n               vasoconstriction?","volume":"11","author":"T Nodwell","year":"2003","journal-title":"Can J Plast Surg"},{"key":"ref6","first-page":"e19","article-title":"Delayed-onset digital ischemia after local anesthetic and low-dose epinephrine\n               use","volume":"42","author":"A F Zhu","year":"2017","journal-title":"J Hand Surg Am"},{"key":"ref7","first-page":"929","article-title":"Urapidil. A reappraisal of its use in the management of hypertension","volume":"56","author":"M Dooley","year":"1998","journal-title":"Drugs"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"1D","DOI":"10.1016\/0002-9149(89)90687-5","article-title":"Pharmacologic profile of urapidil","volume":"64","author":"P A van Zwieten","year":"1989","journal-title":"Am J Cardiol"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1007\/BF01907115","article-title":"Effect of urapidil on ischemic myocardium in anesthetized dogs","volume":"85","author":"H Schad","year":"1990","journal-title":"Basic Res Cardiol"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.hcl.2018.08.002","article-title":"Latest advances in wide awake hand surgery","volume":"35","author":"D H Lalonde","year":"2019","journal-title":"Hand Clin"},{"key":"ref11","first-page":"23","article-title":"Urapidil in the management of hypertension: a review","volume":"20","author":"A M Garrido","year":"2018","journal-title":"Curr Hypertens Rep"}],"container-title":["Handchirurgie \u00b7 Mikrochirurgie \u00b7 Plastische Chirurgie"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2739-3810.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T23:04:33Z","timestamp":1781132673000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2739-3810"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,11]]},"references-count":11,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2026,6,10]]},"published-print":{"date-parts":[[2026,6]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2739-3810","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0722-1819","1439-3980"],"issn-type":[{"value":"0722-1819","type":"print"},{"value":"1439-3980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,11]]}}}