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.
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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.
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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
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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.
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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).
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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.
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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.
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Frequently Asked
Questions
Q: Are
there non-surgical ways to treat hand problems?
A:
There are a number of non-surgical treatment methods like
therapy, medicine, splinting, casting, gentle stretching and
observation.
Q:
What are the causes of congenital hand differences?
A:
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.
Q: Do
all hand problems require surgery?
A:
No. The majority of hand problems are treated with
non-operative means, although complex difficulties actually
necessitate surgical intervention.
Q: If
surgery is required, when is the appropriate time?
A:
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.
Q:
When is the ideal time for a child to get a consultation for
a hand problem?
A:
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.
Q:
Will it be painful to have the stitches removed?
A:
No. In cases involving young children, we make use of
absorbable stitches that do not have to be removed.
Q:
Will my child have a prolonged hospital stay after surgery?
A:
No. Most hand surgeries are performed as outpatient surgery
and the child is permitted to go home the same day.
Q: Can
surgery lessen the pain associated with damage to ligaments
and tendons in the wrist and hands as a result of rheumatoid
arthritis?
A:
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.
Q:
What should I expect after surgery of replacement of finger
joints (MCP/PIP)? What will my new joints be made of?
A:
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.
Q:
What is Dupuytrens Contracture? Can anything be done about
it?
A:
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.
Q:
What causes Missing Digits? Is there anything that can be
done about it?
A:
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.
Q:
What exactly causes Supernumery Digits and is it common?
A:
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.
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