Procedures - Hand Surgery

Dramatic advances have been made in recent years in treating patients with hand injuries, degenerative disorders, and birth defects of the hand. At the forefront of these advances have been plastic surgeons-specialists whose major interest is improving both function and appearance. Plastic surgeons undergo intensive training in hand surgery, and they (along with orthopaedic surgeons and general surgeons) treat patients with a wide range of hand problems. This web page is designed to give you a basic understanding of the most common hand problems: what they are, what plastic surgeons can do for them, and the results you can expect. It can't answer all of your questions, since each problem is unique and a great deal depends on your individual circumstances. Please be sure to ask your doctor if there is anything about the procedure you don't understand.

If You're Considering Hand Surgery:
If you're considering hand surgery, a consultation with a plastic surgeon is a good place to start. The surgeon will examine you, discuss the possible methods of treatment for your problem, and let you know if surgery is warranted. If it is, the surgeon will discuss the procedure in detail, including where the surgery will be performed,the anesthesia and surgical techniques that will be used, possible risks and complications, the recovery and rehabilitation period, and the probable outcome in terms of function and appearance. Don't hesitate to ask your surgeon any questions you may have during the initial consultation-including any concerns you have about the recommended treatment and the costs involved.

Risks and Considerations:
Thousands of successful hand operations are performed each year. While the procedures are generally safe when performed by a qualified and experienced plastic surgeon, complications can arise. In all types of hand surgery, the possible complications include infection, poor healing, loss of feeling or motion, blood clots, and adverse reactions to the anesthesia. These complications are infrequent, however, and they can generally be treated. You can reduce your risks by choosing a qualified surgeon and by closely following his or her advice.

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; and burns, cuts, and other injuries to the skin. Modern techniques have greatly improved the surgeon's ability to restore function and appearance, even in severe injuries.

Among the techniques now used by plastic surgeons:
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. However, recovery may take months, and a period of hand therapy will most often be needed (see Recovery and rehabilitation below.)

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a condition resulting from pressure being placed on the main nerve to your hand. Repetitive movement of the wrist can cause this condition, which is characterised by tingling or loss of sensation in the fingers, pain in the hand or wrist, and weak hand muscles. You may have underlying medical conditions that predispose to developing carpal tunnel syndrome, such as diabetes, thyroid or rheumatoid-type diseases. In certain instances, nerves may be pinched in other locations (neck or elbow) and you may be required to undergo nerve-muscle testing (EMG) prior to considering surgery. This will be evaluated during your consultation.

Initial treatment of carpal tunnel syndrome may include avoiding activities that require wrist movement, taking pain relievers, using cool icepacks to relieve any swelling, and wrapping the wrist in a splint to keep it immobile. However, if the symptoms persist for more than six months, surgery may be the best option for relieving pressure on the nerve.

Surgery for carpal tunnel syndromeis always performed as a day procedure, either under local anaesthetic, with or without sedation, or under a general anaesthetic. Through surgery we are able to relieve pressure on the nerve by severing the band of tissue around the wrist.

Dupuytren’s Disease
Named after Baron Guillaume Dupuytren, who first demonstrated the methods of treating the condition in 1831, Dupuytren’s disease is a progressive condition wherein the tissue between your palm and fingers begins to thicken, forming a cord. Over time, this cord can cause your fingers to bend towards your palm, hindering you from being able to fully extend your fingers.

The exact cause of Dupuytren’s disease is unknown, but is more commonly found in individuals of Northern European descent and those with a family history of the disease. As the disease progresses, it can lead to difficulties in performing daily activities, at which point surgery, the only viable treatment option, may be beneficial.

Your surgeon will discuss surgical options with you and work to find the most appropriate procedure for you. Usually performed under general anaesthetic, surgery is a one-day procedure. However, more complex procedures often require an overnight stay. Rehabilitation exercises and splinting techniques are especially important following surgery.

Trigger Finger
Trigger finger is a condition indicated by clicking, popping, or locking of the affected finger as it bends. This condition may be painful, especially when the finger is forcefully straightened. However, pain is not always a symptom.

Trigger finger occurs when the tendons that move in a smooth tunnel along the length of the finger become stuck. This may be due to narrowing of the tunnel’s entrance, or a lump on the tendon. When caught early, trigger finger can usually be treated with an injection. However, if the condition persists, surgery may be necessary to divide the tight entrance to the tunnel so that the tendon can have more room in which to move. Surgery for trigger finger is always performed as a day procedure, usually under local anaesthetic, with or without sedation.

Ganglion Removal
A ganglion, more commonly known as a benign cyst, forms when the lubricating fluid that fills the joints or tendon sheaths leaks from the joint capsule or sheath into surrounding tissue. The body automatically starts to contain the fluid by forming a sac around it. However, if the fluid leaks out quickly, pressure builds in the sac, making it painful. If the fluid leaks slowly, the ganglion may become large and unsightly.

While a ganglion can occur in any joint, it is most common on the back of the wrist joint, the front of the wrist joint, and the back of the end joint in a finger. In some cases, ganglia arise from the tendons in the hand or fingers. Oftentimes, ganglia are not painful and do not require treatment, as they will often resolve themselves. However, some will result in pain and discomfort or lead to compression of nerves. These ganglia will require treatment, usually by means of surgical removal.

Ganglia can be surgically excised as a day procedure, either under local anaesthetic, with or without sedation, or under general anaesthetic.

Congenital Deformities
Congenital deformities of the hand (deformities a child is born with), can interfere with proper hand growth and cause significant problems in the use of the hand. Fortunately, with modern surgical techniques most defects can be corrected at a very early age-in some cases during infancy, in others at two or three years-allowing normal development and functioning of the hand.

One of the most common congenital defects is syndactyly, in which two or more fingers are fused together. Surgical correction involves cutting the tissue that connects the fingers, then grafting skin from another part of the body. (The procedure is more complicated if bones are also fused). Surgery can usually provide a full range of motion and a fairly normal appearance, although the colour of the grafted skin may be slightly different from the rest of the hand.

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 and Rehabilitation:
Since the hand is a very sensitive part of the body, you may have mild to severe pain following surgery. Your surgeon can prescribe injections or oral medication to make you more comfortable. How long your hand must remain immobilized and how quickly you resume your normal activities depends on the type and extent of surgery and on how fast you heal. To enhance your recovery and give you the fullest possible use of your hand, your surgeon may recommend a course of rehabilitation (physical and occupational therapy) under the direction of a trained hand therapist. Your therapy may include hand exercises, heat and massage therapy, electrical nerve stimulation, splinting, traction, and special wrappings or pressure support garments to control swelling. Keep in mind that surgery is just the foundation for recovery. It's crucial that you follow the therapist's instructions and complete the entire course of therapy if you want to regain the maximum use of your hand.

Procedures by Dr De Aguiar



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