Hand Surgery

Introduction

In case of any impairment in hand, surgery may help to improve the condition. These types of surgeries are very specialized and can treat diseases that cause pain and impair the strength. Also, the function and flexibility of the wrist and fingers can also increase. Goal of the surgery is to restore to near normal the function of fingers and hands injured by trauma or to correct abnormalities present since birth. Specifically, hand surgery can treat:

• Carpal tunnel syndrome – this condition is caused by pressure on the median nerve within the wrist, or carpal tunnel. The symptoms are pain, a tingling sensation, numbness in the fingers, weakness or aching. This condition is associated with several situations such as repetitive motion or overuse of wrist, fluid retention due to pregnancy, injury or trauma to the nerve in the carpal tunnel or rheumatoid arthritis.

• Rheumatoid arthritis – this is very disabling disease that can cause severe inflammation in any joint of the body. It can deform fingers and impair movements of the joint.

• Dupuytren’s contracture – in this disease, there is formation of thick, scar-like tissue bands within the palm and it may extend into the fingers. This causes restricted movements, bending or angle in the fingers into an abnormal position.

The decision to undergo any hand surgery is extremely personal and the patient has to weigh the bene?ts of the surgery against the risks and potential complications that may occur. The plastic surgeon will explain in detail about the procedure and the risks associated with surgery. A consent form should be signed to ensure that the patient fully understands the procedure to be performed, the alternatives and the most likely risks and potential complications.

Some of the risks include:

• Bleeding or formation of hematoma

• Blood clots

• Infection

• Anesthesia risks such as breathing problems and allergy to medications

• Unfavorable or unsightly scarring

• Change in skin sensation due to nerve damage.

Special instructions are given to the patient may include the following:

• The precautions to be taken on the day of surgery

• The type and need of anesthesia during the procedure

• Post-operative care and follow-up

The plastic surgeon will also discuss where the procedure will be performed. Depending on the type of surgery to be performed, it may be done in the plastic surgeon’s office-based minor surgical facility, an ambulatory surgical facility or a major hospital.

Prior to surgery:

• Complete history and general examination is done

• Some blood tests and imaging studies are performed

• Advice about certain medications or adjustment of current medications is given

• Stop smoking well in advance of surgery

• Avoid taking aspirin and certain anti-inflammatory drugs for at least a week before surgery as they can increase bleeding

The procedure

Step 1 – Anesthesia

Medications are administered for the patient to relax during the surgical procedures. The type of anesthesia may include intravenous sedation or general anesthesia. The doctor will recommend the best choice for the surgery.

Step 2 – The incision

• Treating trauma

Tendon repair is the most common traumatic hand or finger injury which often requires hand surgery. When a tendon is cut, it tends to retract from the original wound site. Tendon repair retrieves the retracted tendon and makes attempts to reconnect it using surgical techniques to restore function and movement.

• Carpal tunnel syndrome relief

Pressure on the median nerve in the carpal tunnel is relieved to repair this condition. An incision is made from the middle of the palm to the wrist. This allows access to the constricted tissue which is pressing on the nerve. This surgery cam also be performed by using an endoscope, with smaller incisions.

• Birth deformities can be repaired

When fingers are fused together at birth, it is called as syndactyly. The fingers may be adherent to each other by a web of skin or by partial fusion of bones. Surgery involves separating the two fingers and providing a full range of motion and a normal appearance. In children,, this is important as it will permit more normal finger growth. Techniques such as skin grafting or a local flap procedure like Z-plastymay be done to restore flexibility at the incision site for growth and movement of the fingers.

Step 3 – Closing the incisions

The incisions need to be closed with removable sutures or the plastic surgeon may recommend non-removable sutures in some cases.

Step 4 – See the results

The immediate results of hand surgery will appear gradually as swelling subsides. However, the final outcome may not be apparent for several months.