Royal Free hand unit

About the Royal Free hand unit 

The hand unit at the Royal Free Hospital is run by a multidisciplinary team of plastic surgeons, orthopaedic surgeons hand therapists and psychologists. 

We offer complex reconstructive surgical services for adult and paediatric patients.  

Our surgical group has subspecialty interests in:

  • Arthritis 
  • Peripheral nerve surgery 
  • Congenital hand surgery 
  • Microvascular surgery 
  • Toe-to-hand transfer 
  • Complex trauma  
  • Tendon surgery  
  • Wrist surgery 
  • Osseointegration 
  • Arthroplasty 

We run monthly multidisciplinary complex hand meetings, which patients can be referred to via their GP or a hospital consultant.  

For any referrals please email Mr Dariush Nikkhah or his secretary



Our group is currently leading a NIHR trial (NIHR203610) on WALANT flexor tendon surgery with University College London. This a a feasibility multicentre randomised controlled trial comparing Wide-awake Local Anaesthesia No Tourniquet (WALANT) versus General and Regional Anaesthesia for Flexor Tendon Repair (WAFER Trial). 

Recent Publications from our Hand Unit :

Adrenaline auto-injector injuries: Practical considerations in emergency management in a tertiary hand surgery unit. 

McCaughran PW, Ellis K, Southall C, Zargaran D, Nikkhah D, Mosahebi A. Medicine (Baltimore). 2023 Mar 10;102(10):e32977. doi: 10.1097/MD.0000000000032977. 


Expanding the applications of intramedullary cannulated screw fixation in the hand. 

Leftley C, Nikkhah D, Southall C, Labib A, Moledina J. J Plast Reconstr Aesthet Surg. 2023 May;80:48-55. doi: 10.1016/j.bjps.2023.02.008. Epub 2023 Feb 10. 


Outcomes of single digit replantation for amputation proximal to the flexor digitorum superficialis insertion: A systematic review with meta-analysis. 

Wong S, Banhidy N, Kanapathy M, Nikkhah D. Microsurgery. 2023 May;43(4):408-417. doi: 10.1002/micr.30980. Epub 2022 Oct 26 


Operative outcomes for wide awake local anesthesia versus regional and general anesthesia for flexor tendon repair. 

Kadhum M, Georgiou A, Kanapathy M, Reissis D, Akhavani M, Burr N, Nikkhah D.  Hand Surg Rehabil. 2022 Feb;41(1):125-130. doi: 10.1016/j.hansur.2021.10.312. Epub 2021 Oct 23. PMID: 34700023 


A Comparison of Outcomes at Twelve Weeks of Traditional Button-Over-Nail versus Bone Anchor Repair of Zone I Flexor Digitorum Profundus Tendon Injury. 

Payne A, Sawhney A, Thacoor A, Akhavani M. J Hand Surg Asian Pac Vol. 2022 Feb;27(1):43-48. 


A consecutive series of targeted muscle reinnervation (TMR) cases for relief of neuroma and phantom limb pain: UK perspective. 

Kang NV, Woollard A, Michno DA, Al-Ajam Y, Tan J, Hansen E. J Plast Reconstr Aesthet Surg. 2022 Mar;75(3):960-969. doi: 10.1016/j.bjps.2021.09.068. Epub 2021 


Practical Techniques to Ensure Success in Digital Ring Avulsion Injuries. 

Gardiner S, Friebel TR, Bray J, Anadkat M, Nikkhah D. Plast Reconstr Surg Glob Open. 2021 Aug 19;9(8):e3771. doi: 10.1097/GOX.0000000000003771. eCollection 2021 Aug. 


Getting it right first time: a management protocol for acute and subacute fractures of the scaphoid.

Berber O, Heras-Palou C, Gidwani S. J Hand Surg Eur Vol. 2020 Jul;45(6):643-645. doi: 10.1177/1753193420909491. Epub 2020 Mar 11. PMID: 32157941