What is reconstructive hand surgery?
Plastic surgeons undergo intensive training in hand surgery, and they (along with orthopedic surgeons and general surgeons) treat patients with a wide range of hand problems. There are many common hand problems that our plastic surgeons can solve with surgery.
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.
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. (since hand surgery is performed primarily to correct physical abnormalities, it usually is covered by insurance. Check your policy or call your carrier to be sure.)
What are the risks to hand surgery?
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.
Types of Reconstructive Hand Surgery
Hand Surgery for 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.
Among the techniques now used by plastic surgeons are:
- 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.
Hand Surgery for Carpal Tunnel Syndrome
The carpal tunnel is a passageway through the wrist carrying tendons and one of the hand’s major nerves. Pressure may build up within the tunnel because of disease (such as rheumatoid arthritis), injury, fluid retention during pregnancy, overuse or repetitive motions. The resulting pressure on the nerve within the tunnel causes a tingling sensation in the hand, often accompanied by numbness, aching, and impaired hand function. This is known as carpal tunnel syndrome.
In some cases, splinting of the hand and anti-inflammatory medications will relieve the problem. If this doesn’t work, however, surgery may be required.
In the operation, the surgeon makes an incision from the middle of the palm to the wrist. He or she will then cut the tissue that’s pressing on the nerve, in order to release the pressure. A large dressing and splint are used after surgery to restrict motion and promote healing. The scar will gradually fade and become barely visible.
The results of the surgery will depend in part on how long the condition has existed and how much damage has been done to the nerve. For that reason, it’s a good idea to see a doctor early if you think you may have carpal tunnel syndrome.
Hand Surgery for Rheumatoid Arthritis
Rheumatoid arthritis, an inflammation of the joints, is a disabling disease that can affect the appearance and the function of the hands and other parts of the body. It often deforms finger joints and forces the fingers into a bent position that hampers movement.
Disabilities caused by rheumatoid arthritis can often be managed without surgery-for example, by wearing special splints or using physical therapy. For some patients, however, surgery offers the best solution. Whether or not to have surgery is a decision you should make in consultation with your surgeon and your rheumatologist.
Surgeons can repair or reconstruct almost any area of the hand or wrist by removing tissue from inflamed joints, repositioning tendons, or implanting artificial joints. While your hand may not regain its full use, you can generally expect a significant improvement in function and appearance. Still, it’s important to remember that surgical repair doesn’t eliminate the underlying disease. Rheumatoid arthritis can continue to cause damage to your hand, sometimes requiring further surgery, and you’ll still need to see your rheumatologist for continuing care.
Hand surgery for Dupuytren’s Contracture
Dupuytren’s contracture is a disorder of the skin and underlying tissue on the palm side of the hand. Thick, scar-like tissue forms under the skin of the palm and may extend into the fingers, pulling them toward the palm and restricting motion. The condition usually develops in mid-life and has no known cause (though it tends to run in families).
Surgery is the only treatment for dupuytren’s contracture. The surgeon will cut and separate the bands of thickened tissue, freeing the tendons and allowing better finger movement. The operation must be done very precisely since the nerves that supply the hand and fingers are often tightly bound up in the abnormal tissue. 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, and a thin, fairly inconspicuous scar.
Hand surgery for Congenital Deformities
Congenital deformities of the hand 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 color 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.
What is hand surgery recovery like?
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 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.