Hand Surgery
Hand surgery and your plastic surgeon
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 orthopedic
surgeons and general surgeons) treat patients with a wide range of hand
problems.
This information 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 (in the surgeon's office, an outpatient surgery
center, or a hospital), 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. (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.)
All surgery carries some uncertainty and risk
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:
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
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.
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 to
strengthen weakened areas. 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.
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 has a tendency 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 (see Recovery and rehabilitation.), and a thin, fairly inconspicuous
scar.
Congenital defects
Congenital deformities of the hand-that is, 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
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.
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 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.
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