Hand Surgery Clinic (Microsurgery)

Overview

Hand surgery is a broad concept that encompasses a wide range of procedures. Hand surgeons aim to restore hand and finger function. However, hand surgeons also attempt to make the hand appear as natural as possible.

Hand microsurgery can be performed for a variety of causes, including hand injuries, rheumatic disorders that alter and harm the structures of the hand, such as osteoarthritis and rheumatoid arthritis, degenerative alterations to the hand's structures, hand problems or deformities that are present at birth, known as congenital & hand infections are common.

What are the Different Types of Hand Microsurgery?

Many different types of surgeries can be performed on the hand. It depends on the underlying cause of the problem. These procedures include:

• Skin grafts

Skin grafts for the hand include restoring or connecting skin to a missing area of the hand. This operation is most commonly used to treat fingertip amputations or injuries. Skin grafts are performed by connecting a portion of healthy skin from another region of the body, known as the donor site, to the wounded area.

• Skin flaps

Skin flaps for the hand, like skin grafts, entail removing skin from another region of the body. However, this procedure makes use of skin that has its own blood supply. This is due to the fact that the portion of skin utilized comprises the underlying blood veins, fat, and muscles. When a region of lost skin does not have an adequate blood supply, flaps may be employed. This might be due to the location, vascular injury, or significant tissue damage.

• Closed reduction and fixation

When there is a bone fracture or fractured bone in a section of the hand, including the fingers, this may be employed. This form of surgery realigns the shattered bone before immobilizing it to allow it to recover. Internal devices, such as wires, rods, splints, and casts, can be used to immobilize the patient.

• Tendon repair

Tendons are the fibers that join muscle to bone. Tendon repair in the hand is a difficult surgery because of the structure of the tendon. Tendon injuries can occur due to infection, trauma, or sudden rupture. There are 3 types of tendon repair: primary, delayed primary, or secondary.

• Primary repair of an acute or sudden injury is often done within 24 hours of the injury.  This is usually a direct surgery to fix the injury.
• Delayed primary repair is usually done a few days after the injury, but while there is still an opening in the skin from the wound.
• Secondary repairs may occur 2 to 5 weeks or longer after the injury. They may include tendon grafts. This is when tendons from other areas of the body are inserted in place of the damaged tendon. Or other more complex procedures may be used.
• Nerve repairs

A hand injury might cause nerve damage. This can result in a loss of hand function as well as a loss of sensation in the hand. Nerve damage may recover on their own in some cases. Others may need surgery. Surgery is usually performed 3 to 6 weeks following the accident. This is the optimal moment for nerve repairs associated with other more serious injuries.

In circumstances when nerve damage is not associated with more serious injuries, surgery to examine the injured nerve is generally performed immediately after the incident. This enhances the likelihood of complete recovery.

If the nerve is cut or severed, it may be fixed by reattaching it to the other end of the nerve, or a nerve graft may be done. This involves replacing the damaged nerve with nerves taken from other areas of the body.

• Fasciotomy

This operation is performed to aid in the treatment of compartment syndrome. When there is swelling and elevated pressure in a tiny region, or compartment, in the body, this painful condition arises. This is frequently triggered by an injury. This pressure can disrupt blood flow to the body's tissues and disrupt function. A compartment syndrome in the hand can cause significant and escalating discomfort as well as muscular weakness. It might produce a change in the color of the fingers or nailbeds over time.

For a fasciotomy, your doctor will make a cut or incision in your hand or arm. This decreases the pressure, lets the muscle tissue swell, and restores blood flow. Any tissue inside the area that is already damaged may be removed at this time. This procedure helps prevent any further damage and decrease in function of the affected hand.

• Surgical drainage or debridement

Infections of the hands are quite prevalent especially in those with DM. Rest, heat, elevation, antibiotics, and surgery may be used to treat hand infections. If you have a hand sore or an abscess, surgical drainage may help remove any pus. If the infection or wound is serious, debridement may be utilized to clear the wound of dead and infected tissue. This helps to promote healing and avoids future infection.

• Joint replacement

This operation, also known as arthroplasty, is performed to treat severe hand arthritis. It entails replacing a joint damaged by arthritis with an artificial joint. This prosthetic joint might be composed of metal, plastic, silicone rubber, or even your own body tissue like a tendon.

• Replantation

This operation reattaches a body part that has been totally cut or separated from the body, such as a finger, hand, or toe. The objective is to re-establish as much functionality as feasible. Microsurgery is used in replantation. This is a complex sort of surgery that requires the use of tiny tools and is performed under magnification with a microscope. In certain extreme circumstances, more than one operation may be required.

What Happens During a Consultation for Hand microsurgery?

Your entire candor during your hand surgery consultation is critical to the effectiveness and safety of your hand procedure. You will be questioned about your health, desires, and lifestyle.

During your hand surgery consultation be prepared to discuss:

• Why you want the procedure, your expectations and desired outcome.
• Medical conditions, drug allergies and medical treatments.
• Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs.
• Previous surgeries.

Your plastic surgeon will also:

• Evaluate your general health status and any pre-existing health conditions or risk factors.
• Examine your hand in detail.
• Discuss your options and recommend a course of treatment to restore hand function.
• Discuss likely outcomes of hand surgery and any risks or potential complications.

Before the Procedure

• Eating before surgery

Remember not to eat or drink anything after midnight prior to your surgery, or as directed by your anesthesiologist. This includes water, breath mints and even chewing gum. Having food in your stomach can create a risk during surgery.

• Medications

Consult your doctor about if you should stop taking regular medications, herbal supplements, or aspirin before surgery. If you are instructed to continue taking your prescription, do so with merely a sip of water. Take no aspirin or aspirin-containing products for at least seven days before your surgical operation. Any anti-inflammatory medicine falls within this category. If you have any questions about this or any other drug you are taking on a regular basis, please contact your physician's nurse or medical practitioner.

• Plan to arrive early for surgery

You must plan to arrive at the hospital at least two hours prior to your scheduled surgery time. Your surgery coordinator will call you with this time one day prior to your surgery date.

• Arrange for a ride after surgery

Make arrangements ahead of time for a responsible adult to transport you home and to be accessible to you following surgery. You will not be able to drive yourself or take a taxi home. Please make plans for transportation.

• Questions about anesthesia

Your anesthesiologist may call you the night before your surgery to answer any questions you have regarding anesthesia. Your surgery coordinator does not know who the anesthesiologist will be and cannot answer questions pertaining to anesthesia or anesthesia billing.

What Hand Microsurgery Can Treat?

1. Repairing hand injuries

The most common procedures in hand surgery are those done to repair injured hands, including injuries to the:

• Tendons, nerves, blood vessels and joints.
• Fractured bones.
• Burns, cuts and other injuries to the skin.

Techniques used by Specialist Plastic Surgeons include:

• Grafting:
  The transfer of skin, bone, nerves, or other tissue from a healthy part of the body to repair the injured part
• Flap surgery:
  Moving the skin along with its underlying fat, blood vessels, and muscle from a healthy part of the body to the injured site
• Replantation or transplantation:
  Restoring accidentally amputated fingers or hands using microsurgery, an extremely precise and delicate surgery performed under magnification. Some injuries may require several operations over an extended period of time

In many cases, surgery can restore a significant degree of feeling and function to injured hands.

2. Treating Carpal Tunnel Syndrome

The carpal tunnel is a channel in the wrist that carries tendons and one of the primary nerves of the hand. Disease (such as rheumatoid arthritis), injury, fluid retention during pregnancy, overuse, or repeated movements can all cause pressure to build up within the tunnel. The strain on the nerve within the tunnel produces tingling in the hand, which is frequently accompanied by numbness, pain, and reduced hand function. This is referred to as carpal tunnel syndrome. In certain circumstances, a hand splint and anti-inflammatory drugs can alleviate the condition. If this does not work, surgery may be necessary.

The goal of carpal tunnel surgery is to relieve pressure on the nerve by removing tissue that is pushing on it. The outcome of the operation will be determined in part by how long the problem has lasted and how much nerve damage has occurred. As a result, if you suspect you have carpal tunnel syndrome, you should contact a Specialist Plastic Surgeon as soon as possible.

3. Treating rheumatoid arthritis

Rheumatoid arthritis, or joint inflammation, is a debilitating illness that can impair the look and function of the hands and other body parts. It frequently deforms finger joints and puts the fingers into a bent posture, limiting mobility.

Rheumatoid arthritis-related disabilities can frequently be addressed without surgery, for example, by wearing customized splints or employing physical therapy to improve damaged regions. However, for certain people, surgery is the best option. You should contact with your Specialist Plastic Surgeon and your rheumatologist before deciding whether or not to have surgery.

By removing tissue from inflammatory joints, relocating tendons, or implanting prosthetic joints, surgeons can repair or reconstruct practically any part of the hand or wrist. While your hand may not be fully functional, you may expect a dramatic improvement in function and look.

It's critical to realize that surgical correction does not cure the underlying condition. Rheumatoid arthritis might continue to harm your hand, necessitating more surgery. You will need to see your rheumatologist for follow-up care.

4. Treating Dupuytren’s Contracture

Dupuytren's contracture is a skin and underlying tissue condition on the palm side of the hand. Thick, scar-like tissue develops beneath the skin of the palm and may extend into the fingers, pushing them toward the palm and limiting movement. The illness generally appears in middle age and has no known etiology, however it does run in families.

Dupuytren's contracture can only be treated surgically. A Specialist Orthopedic Surgeon will remove and split the thicker tissue bands, releasing the tendons and allowing for more finger mobility. Because the nerves that feed the hand and fingers are frequently firmly tied up in the aberrant tissue, the procedure must be performed with absolute accuracy.

In some cases, skin grafts are also needed to replace tightened and puckered skin. The results of the surgery will depend on the severity of the condition. You can usually expect significant improvement in function, particularly after physical therapy.

5. Congenital Deformities

Congenital hand abnormalities can impede appropriate hand development and cause major issues with hand usage. Fortunately, most problems may be corrected at a young age using modern surgical procedures.

Syndactyly is a frequent congenital condition in which two or more fingers are fused together. Surgical correction entails removing the connective tissue between the fingers and then transplanting skin from another region of the body. If bones are additionally fused, the surgery becomes more complex.

Although the color of the grafted skin may be somewhat different from the rest of the hand, surgery may typically restore complete range of motion and a rather normal look.

Other common congenital defects include short, missing, or deformed fingers, immobile tendons, and abnormal nerves or blood vessels. In most cases, these defects can be treated surgically and significant improvement can be expected.

Recovery&  Rehabilitation

Because the hand is such a sensitive area of the body, you may experience minor to severe discomfort after surgery. Where necessary, your Specialist Orthopedic Surgeon will recommend injections or oral pain medication.

Dressings and a splint may be required following surgery to limit motion and facilitate recovery, depending on your operation. The length of time your hand must be immobilized and how quickly you may resume regular activities are determined by the type and degree of surgery as well as how quickly you heal.

Your surgeon may prescribe a course of physical and occupational therapy under the supervision of a skilled hand therapist to aid your recovery and offer you the most use of your hand feasible. Hand exercises, heat and massage treatment, electrical nerve stimulation, splinting, traction, and specific wrappings to decrease swelling may all be part of your therapy. If you wish to regain full use of your hand, you must strictly adhere to the therapist's recommendations and finish the whole course of therapy.

What Are the Risks of Hand Microsurgery?

The choice to have hand surgery is incredibly personal, and you must choose if the advantages outweigh the risks and potential consequences. Your plastic surgeon and/or team will thoroughly discuss the dangers of surgery.

You will be required to sign permission paperwork to verify that you completely understand the treatment, the alternatives, and the most likely risks and consequences associated with hand surgery.

Possible hand surgery risks include:

• Allergies to tape, suture materials and glues, blood products, topical preparations or injected agents
• Anesthesia risks
• Bleeding (hematoma)
• Blood clots
• Change in skin sensation
• Damage to deeper structures – such as nerves, blood vessels, muscles and lungs – can occur and may be temporary or permanent
• Deep vein thrombosis, cardiac and pulmonary complications
• Infection
• Injury to the blood vessels, nerves or tendons
• Pain, which may persist
• Poor healing of incisions
• Possibility of revisional surgery
• Skin contour irregularities
• Skin discoloration/swelling
• Unexpected hand swelling
• Unfavorable scarring

Make sure you ask the following questions: It is critical to ask your plastic surgeon detailed questions regarding your treatment. It's normal to experience some worry, whether it's enthusiasm for your new appearance or preoperative stress. Don't be afraid to express your emotions to your plastic surgeon.

Cost

Cost is always a consideration for surgery. Prices for individual procedures can vary widely between Specialist Plastic Surgeons. Some factors that may influence the cost include the surgeon’s experience, the type of procedure used and the geographic location of the office.

Costs associated with the procedure may include:

• Surgeon’s fee.
• Hospital or surgical facility costs.
• Anaesthesia fees.
• Prescriptions for medication.
• Post-surgery garments.
• Medical tests.

Your surgeon should welcome any questions you may have regarding fees.

Conclusion

If your hand is affected in any way, surgery may help you. This highly specialized surgery can address disorders that cause discomfort and affect your wrist and finger strength, function, and flexibility. Surgery attempts to restore to near-normal function of fingers and hands harmed by trauma or to address congenital defects.