Ralf was no stranger to hand surgery. Four years earlier, during the pandemic, I had operated on his left thumb, performing a trapeziectomy using the Arthrex Mini TightRope technique. With that successful experience behind him, Ralf didn’t need much convincing when it came to his right thumb. But in the years since, surgical options had continued to evolve.

We discussed the various techniques available, including tendon reconstruction and the Biopro implant, but ultimately settled on the Arthrex FiberLock anchor system—a newer single-incision technique I now favor for many older patients. This approach reduces surgical exposure while providing excellent stabilization, minimizing recovery time and improving comfort.

In early April, we proceeded with the surgery. Just a few weeks later, Ralf was waiting to see me again—this time as my very first patient at Heritage Hand and Plastic Surgery. He has the unique distinction of being both my last surgical patient at MSU and my first at Heritage—a transition that feels deeply symbolic to me.

Over the past nine weeks, Ralf has steadily regained his pinch strength, diligently following his hand therapy program. Our visits have been filled with fascinating conversations about his long career in naval nuclear science—at least the parts he’s permitted to share. In turn, I shared stories from my own family’s medical history, including my grandfather’s post-war assignment from the UK to visit Los Alamos and study the effects of atomic weapons on human casualties—a grim but historically significant report.

Every patient has a story. Ralf’s reminds me why I chose to open Heritage Hand and Plastic Surgery: to offer personal, expert care in an environment where every patient is seen, heard, and given the time and attention they deserve.

The post From Michigan State to Heritage Hand and Plastic Surgery: A Special Patient Journey appeared first on Heritage Hand and Plastic Surgery.

Throughout my professional career, I have worked as a plastic and hand surgeon within some of the world’s largest healthcare systems — 13 years in the British National Health Service, followed by advanced fellowship training in hand surgery in the United States, and most recently, 15 years on faculty at Michigan State University. What I have come to recognize—something my great-grandfather could have told me generations ago—is that the best care occurs when nothing stands between the patient and their physician. This timeless principle serves as the foundation of Heritage Hand and Plastic Surgery.

Too often in modern healthcare, the simple experience of seeing your surgeon, having a conversation, and proceeding to surgery has been lost in an increasingly institutionalized and bureaucratic system. My goal is to reclaim that experience. From the moment you enter the office, you will find yourself surrounded by my family’s heritage — heirlooms dating back to 1850 — honoring ancestors who were pioneers in ophthalmology, orthopedic implant development, sterile technique, and plastic surgery across multiple generations and through both World Wars. You will be welcomed with coffee, dignity, and respect.

For patients undergoing surgery, the experience is entirely different from that of an ambulatory surgery center or hospital. Surgery is performed in a calm, office-based setting without the unnecessary complexities and costs that often accompany institutional care. Patients may eat beforehand, remain awake, and even drive themselves home afterwards. For those who prefer distraction during their procedure, I offer immersive virtual reality using a system I developed called Wide Awake VR, which has been shown to enhance the patient experience and reduce anxiety.

Office-Based Surgical Offerings

In-office procedures range from simple dermatologic excisions of benign and malignant skin lesions to complex hand surgeries, including:

• Carpal Tunnel Release
• Dupuytren’s Fasciectomy
• Lacertus Fibrosus Release (often an overlooked contributor to hand pain)
• Cubital Tunnel Release
• Ganglion and Mucous Cyst Removal
• Trigger Finger Release (especially common in diabetic and older populations)
• Mohs surgery reconstruction
• Fat transfer to hand tissue and joints

Operating Room-Based Surgical Offerings

While many procedures can be safely and comfortably performed in the office, certain surgeries still require the resources of a fully equipped operating room. In these settings, I provide:

• Complex and deep reconstructive surgeries of the wrist, hand, and forearm
• Thumb arthroplasty and wrist arthroplasty for degenerative joint conditions
• General orthopedic surgeries of the hand and wrist including trauma management
• Plastic surgical reconstructive services, including soft tissue reconstruction, skin grafts and flaps
• Body contouring and aesthetic reconstructive procedures

Why Wide-Awake Surgery?

I believe unnecessary anesthesia is often not in the best interest of patients, particularly as we age. Using specialized techniques I learned directly from Dr. Don Lalonde—the father of awake hand surgery—I perform procedures under local anesthesia without a tourniquet, in what is known as WALANT (Wide Awake Local Anesthesia No Tourniquet) surgery. This technique allows patients to remain fully awake, fully informed, and fully in control.

Because no sedation or general anesthesia is used, patients:

• Have no need to stop medication or seek anesthesia clearance from other specialist
• Recover more quickly
• Retain full mental clarity post-procedure
• Can drive themselves home if they feel safe to do so
• May sign documents and return to work the same day
• Faster recovery

In addition, many patients are now traveling considerable distances to see me, specifically to avoid the complexities, delays, and financial burdens of institutionalized healthcare in their own states and cities. They are seeking not only a streamlined, personalized experience, but also expert-level options for the management of hand pain, peripheral nerve decompression, and complex nerve-related conditions that often go underdiagnosed or undertreated elsewhere.

For many, particularly those with high-deductible health plans, office-based surgery costs only a fraction of what hospital-based care would entail — often saving thousands of dollars without sacrificing safety or outcomes.

A Return to Patient-Centered Care

By focusing on the patient’s experience and wellness, Heritage Hand and Plastic Surgery offers an environment where individuals can actively participate in their care, free from the burdens of large healthcare systems. This model allows me to provide exceptional, independent hand and plastic surgical care in an efficient, cost-effective, and compassionate manner.

I am honored to bring this vision to life and look forward to caring for you and your family.

— James Clarkson MD
Heritage Hand and Plastic Surgery

The post Announcing The Launch Of Heritage Hand And Plastic Surgery appeared first on Heritage Hand and Plastic Surgery.

In my work as a hand surgeon, I’ve begun to explore this question. Traditional metrics like satisfaction feel too clinical, too detached from the human element of healing. In two published studies on wide-awake hand surgery performed in office settings, I took a different approach: I measured patient joy. The findings were eye-opening. Patients undergoing procedures under local anesthesia—many of whom started out anxious—reported remarkable levels of enjoyment when paired with immersive virtual reality (VR) experiences during surgery.

Picture this: instead of staring at a sterile ceiling, patients join me in a virtual world, watching amazing experiences or interactive stories unfold as I work. We talk and laugh together about the show, which I can also watch on a screen as I work. The immersive VR doesn’t just distract—it transforms the experience. Those most nervous at the outset often ended up the most delighted, laughing or marveling at the technology mid-procedure. It’s a stark contrast to the cold, impersonal surveys we’re used to.

This shift matters. Joy isn’t just a feel-good bonus; it’s a signal of deeper connection, reduced stress, and better recovery. Medicine has long focused on outcomes like pain or complications—vital, yes—but what if we also prioritized the emotional journey? The doctor-patient relationship deserves that depth. My hope is that more physicians will start measuring joy, not just satisfaction, to honor the full humanity of those we serve. After all, healing should lift the spirit, not just mend the body.

My publications included randomized trials and hundreds of patients:

• Virtual Reality Improves Patient Experience (PDF)
• Virtual Reality Improves Patient Experience Trial (PDF)

The post Why Don’t Doctors Measure Patient Joy More Often? appeared first on Heritage Hand and Plastic Surgery.