What is Hand Surgery?

Hand surgery is a general term that encompasses a wide array of different types of surgery on the hand. Aside from attempting to restore the function of the hand, surgeons who perform hand surgery also try to improve the cosmetic appearance of the hand.

Effects of Hand Surgery

Hand surgery will alleviate problematic conditions such as carpal tunnel syndrome, rheumatoid arthritis, Dupuytren’s contracture and congenital defects.

The specific procedure suitable for you depends on your condition. Nevertheless, a doctor can transfer skin, bone, nerves or other tissue from a healthy part of the body to mend the injured section through grafting; utilize flap surgery for moving the skin along with its underlying fat, blood vessels, and muscles; or apply re-plantation, also known as transplantation, through microsurgery performed under magnification.

Candidates for Hand Surgery

The best candidates are those who are under a great deal of distress caused by hand injuries. Hand surgery covers a wide range of procedures that are used to repair:

  • Hand injuries
  • Carpal Tunnel Syndrome
  • Rheumatoid Arthritis
  • Dupuytren’s Contracture
  • Congenital defects

Your Consultation

BHMG’s Board Certified Surgeon will obtain a complete medical history and administer a thorough examination to assess your overall health. Ideally, the patient should have no health problems.

Photographs will be taken before and after the surgery.

Antibiotics will be prescribed during surgery to prevent infection. You should also avoid taking drugs containing aspirin to reduce the possibility of excess bleeding. You may also be required to shower with an antiseptic soap the night before or the morning of your scheduled surgery.

The Hand Surgery Procedure

In some cases of hand surgery, more than one operation is required over an extended period of time. Hand surgery may involve the following procedures:

Skin Grafts
Replacing or attaching skin to a part of the hand that does not have skin.

Skin Flaps

Skin flaps are much like skin grafts. With skin flap though, the skin that is recovered has its own blood supply. Underlying blood vessels, fat, and muscles make up the section of skin used.

Closed Reduction and Fixation

This type of procedure re-aligns the fractured bone and then immobilizes the area at the time of healing.

Tendon Repair

There are three classifications of tendon repair: primary, delayed primary, or secondary. Primary repair of an acute injury is customarily completed within 24 hours of the injury. On the other hand, delayed primary repair is usually done a few days following the injury, while the opening in the skin from the wound is still evident. Lastly, secondary repairs may take place 2 to 5 weeks or longer after the injury. With primary repairs, direct surgical correction of the injury is normally performed. Secondary repairs, however, may involve tendon grafts (inserting tendons from other areas of the body in place of the damaged tendon) or other more complicated procedures.

Nerve Repairs

The hand has three main nerves: the ulnar nerve, the median nerve, and the radial nerve. Injuries involving the hand may cause damage to these nerves that may result in decreased ability to mobilize the hand and experience feeling. While some injuries heal on their own, others necessitate surgery. In severe cases, the nerve may be corrected by reattaching it directly to the other end of the nerve, or by performing a nerve graft.

Fasciotomy

This procedure is carried out to treat compartment syndromes. A compartment may be defined as a three-dimensional space in the body that is surrounded by fascia or bone and contains arteries, nerves and veins. A compartment syndrome then is a condition that arises when intracompartmental tissue pressure increases within a space in the body, usually brought about by trauma, which can hinder the circulation to the body tissues and ruin function.

Surgical Drainage and/or Debridement

Most people commonly seek treatment for infections of the hand. Treatments used to cure infections of the hand include rest, use of heat, elevation, antibiotics and surgery. Surgical drainage may be employed in cases where there is an abscess in the hand to help remove the collection of pus. Debridement or cleansing of a wound to avoid further infection and to help promote healing, may be utilized if the infection or would is severe.

Arthroplasty

Arthroplasty, otherwise known as “joint replacement,” may be used in patients with severe arthritis. This involves replacing a damaged joint with an artificial one made out of metal, plastic silicone rubber, or the patient’s own body tissue (such as a tendon).

Recovery

Given the fact that the hand is a very sensitive part of the body, patients may experience mild to severe pain subsequent to the surgery. Depending on the type and extent of surgery and on how fast the healing takes place, the hand should be remained immobilized and normal activities are put on hold.

The surgeon may propose a course of rehabilitation (physical and occupational therapy) to improve your recovery with the direction of a trained hand therapist.

Risks

As with any other surgery, some risks and side effects may occur. These include possible infection, poor healing, loss of feeling or movement of the hand and fingers, blood clots and adverse reactions to the anesthesia.

FAQs

Are there non-surgical ways to treat hand problems?

There are a number of non-surgical treatment methods like therapy, medicine, splinting, casting, gentle stretching and observation.

Are there non-surgical ways to treat hand problems?

There are a number of non-surgical treatment methods like therapy, medicine, splinting, casting, gentle stretching and observation.

What are the causes of congenital hand differences?

The development of the human hand may be influenced by a number of factors. In general, it is brought about by a spontaneous alteration at some point in the development, and is not necessarily from any outside factor or event of pregnancy.

Do all hand problems require surgery?

No. The majority of hand problems are treated with non-operative means, although complex difficulties actually necessitate surgical intervention.

If surgery is required, when is the appropriate time?

Most of hand surgeries are not executed during the newborn period. Surgeries are oftentimes delayed until the child is 12 to 18 months old, at the youngest.

When is the ideal time for a child to get a consultation for a hand problem?

As quickly or early as possible, although there is no emergency. It is advised that the child be seen early so physicians can track the growth and progress.

Will it be painful to have the stitches removed?

No. In cases involving young children, we make use of absorbable stitches that do not have to be removed.

Will my child have a prolonged hospital stay after surgery?

No. Most hand surgeries are performed as outpatient surgery and the child is permitted to go home the same day.

Can surgery lessen the pain associated with damage to ligaments and tendons in the wrist and hands as a result of rheumatoid arthritis?

The hand pain in rheumatoid arthritis (RA) may stem from a wide range of causes, primarily the inflammation of the synovial membranes. Synovium is specialized tissue that facilitates gliding to happen and secretes the lubricant and nutrient synovial fluid necessary to have normal joint function and the function of some tendons. In rheumatoid arthritis, this tissue turns out to be inflamed and turns out to be a factor in destroying the joint and its adjacent ligaments (which are the ones that effectively constrain the joint and make it stable but mobile). As the joints and ligaments decompose, they may become volatile and deviate or adopt abnormal attitudes or positions, placing augmented strain on the remaining ligaments. These inflamed and swollen joints are painful in their own right, and some pain may arise from the joint surfaces or from the capsule that surrounds the joint including the ligaments that bear abnormal strains.

There may also be other causes of pain that may happen in rheumatoid arthritis in the hand. The most significant causes are nerve compression pains from swelling of adjacent joints or tendons and subsequent compression of the nearby nerves. One good example of this is rheumatoid arthritis linked with Carpal Tunnel Syndrome. Those suffering from rheumatoid arthritis with any new type of hand pain should seek consultation from a hand specialist or rheumatologist, and regular checks by a rheumatologist or hand surgeon are recommended in this condition. The specific indications for surgery for pain may then be discussed in detail.

What should I expect after surgery of replacement of finger joints (MCP/PIP)? What will my new joints be made of?

The MCP (metacarpophalangeal) joints are the knuckle joints where the finger unites the palm. The PIP joints (proximal interphalangeal) are the middle joints of the fingers. MCP replacement with prostheses is most frequently carried out for advanced rheumatoid arthritic change with deviation and loss of function at these joints. Considerably, the most common replacement joint is made from Silicone rubber. Because of its structure, it does not precisely reproduce the biomechanics of the joint it replaces; therefore, full function is never restored. Additionally, it is made of a friable material, and because of this, it is subject to attritional wear. Most surgeons, therefore, use it almost entirely in the low demand low load hands of rheumatoid patients where it can be very successful indeed.

In addition, the joint has no innate lateral stability, which is not a problem in the MCP because the adjacent joints bolster it. But in the PIP, it can create problems resisting lateral stress.

Most medical professionals believe that the ideal range of motion after an MCP joint replacement is approximately 30 to 40 degrees, in contrast with 90 degrees in the unaffected hand.

What is Dupuytrens Contracture? Can anything be done about it?

Dupuytrens Contracture is a genetically predisposed disease of unidentified etiology. It is common in countries like Scandinavia, Britain, as well as the British colonies, where they received the “Viking diaspora”. But it is virtually unheard of in native Africans.

The condition is simply a fibrous scar-like affliction of the fascial layer of the palm, which is the layer that combines the skin of the palm or sole to the underlying skeleton. Without this layer, the skin would slide about as it does on the back of the hand, restraining firm grasping. The initial symptom of the affliction is a lump, usually in the palm parallel with the ring or little finger. This may continue for many years without progressing. On the contrary, it may develop bands running from the lump to the finger and palpable beneath or even within the skin. These bands subsequently contract slowly and draw the finger inexorably toward the palm. They may multiply into other adjacent digits or appear in the opposite hand or foot. Very seldom, they can afflict the penis.

Despite the press hype that this can be treated, there is no medical treatment for Dupuytrens Contracture. Surgery is reserved for treatment of contractures and is not generally suitable for the isolated nodule, since the paradox of surgery is that it may accelerate the development of the disease.

A simple surgery is often effective, and further surgery may be needed after some years should the disease progress or appear elsewhere. In severe cases, recurrence can be delayed or contained by careful use of skin grafts to remove involved skin areas in discrete zones of the hand.

There are associations with the disease, although there are no serious systemic manifestations, and there is no tendency of malignancy of any sort.

What causes Missing Digits? Is there anything that can be done about it?

Numerous reasons may be attributed to this problem. The thing is, this is very unlikely to correspond to a disability and very unlikely to have some bearing on whether the child has a happy and fulfilled life or not.

What exactly causes Supernumery Digits and is it common?

This condition depicts extra digits on the little finger side of the hand, or ulnar border. The removal of these is uncomplicated since the digits are usually connected by a slight stalk, rather than truly articulating with the rest of the skeleton. Heredity may be a cause of this condition.