Overview of Hand Surgery

Overview of Hand Surgery

What is
hand surgery?

Hand surgery is a broad term that covers many different types of procedures.
Plastic surgeons who do hand surgery aim to restore hand and finger function. But
they also try to make the hand look as normal as possible, as well. Hand surgery may
be done for many reasons, including:

  • Hand injuries

  • Rheumatic diseases, such as osteoarthritis
    and rheumatoid arthritis, that change and damage the structures in the
    hand

  • Degenerative changes to the structures in
    the hand

  • Problems or defects that are present at
    birth, or congenital

  • Infections

What are
the different types of hand surgery?

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

Skin grafts

Skin grafts are done by replacing or attaching
skin to a part of the hand that has missing skin. This surgery is most often
done for fingertip amputations or injuries. Skin grafts are done by taking a
piece of healthy skin from another area of the body, called the donor site, and
attaching it to the injured area.

Skin flaps

Like a skin graft, a skin flap involves taking
skin from another part of the body. But this procedure uses skin that has its
own blood supply. That’s because the section of skin that is used includes the
underlying blood vessels, fat, and muscles. Flaps may be used when an area that
is missing skin does not have a good blood supply. This may be because of the
location, damage to the vessels, or extensive tissue damage.

Closed reduction and fixation

This may be used when there is a bone
fracture, or broken bone, in part of the hand, including the fingers. This type
of surgery realigns the broken bone and then holds it in place, or immobilizes
it, while it heals. Immobilization can be done with internal fixtures, such as
with wires, rods, splints, and casts.

Tendon repair

Tendons are the fibers that join muscle to
bone. Tendon repair is a difficult surgery because of the structure of the
tendon. Tendon injuries can occur due to infection, injury, 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

An injury can damage the nerves in the hand.
This can cause a loss of hand function and a loss of feeling in the hand. Some
nerve injuries may heal on their own. Others may require surgery. Generally,
surgery is done about 3 to 6 weeks after the injury. This is the best time for
nerve repairs that are linked with other more complicated injuries.

In cases where nerve damage is not linked to
more complicated injuries, surgery to check the damaged nerve is usually done
soon after the injury. This increases the chance of a full 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 procedure is done to help treat
compartment syndrome. This painful condition occurs when there is swelling and
increased pressure in a small space, or compartment, in the body. Often this is
caused by an injury. This pressure can interfere with blood flow to the body
tissues and destroy function. In the hand, a compartment syndrome may cause
severe and increasing pain and muscle weakness. Over time, it can cause a change
in color of the fingers or nailbeds.

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

Hand infections are very common. Treatment for
hand infections may include rest, using heat, elevation, antibiotics, and
surgery. If there is a sore or abscess in the hand, surgical drainage may help
remove any pus. If the infection or wound is severe, debridement may be used to
clean dead and contaminated tissue from the wound. This prevents further
infection and helps promote healing.

Joint replacement 

This type of surgery, also called
arthroplasty, is used in cases of severe hand arthritis. It is done by replacing
a joint that has been destroyed by arthritis with an artificial joint. This
artificial joint may be made of metal, plastic, silicone rubber, or your own
body tissue, such as a tendon.

Replantation

This type of surgery reattaches a body part,
such as a finger, hand, or toe, which has been completely cut or severed from
the body. The goal is to restore as much function as possible. Replantation uses
microsurgery. This is a complex type of surgery that uses tiny tools and is done
under magnification using a microscope. In some severe cases, more than 1
surgery may be needed.

What are
the risks of hand surgery?

Most surgery has the risks of anesthesia and bleeding. Other risks depend on the
type of surgery being done. They may include:

  • Infection

  • Incomplete healing

  • Loss of feeling or movement of the hand or
    fingers

  • Blood clots

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