Significant progress has been made in recent years in the treatment of hand injuries, degenerative diseases and congenital defects. Plastic surgeons have played a major role in this progress, their main focus being to improve both function and appearance.
The most frequent procedures in hand surgery involve repairing damage to tendons, nerves, blood vessels and joint, broken bones and burns and skin injuries. Modern techniques have greatly improved the surgeon’s ability to correct both function and appearance in serious burns.
The techniques currently used by plastic surgeons include:
Grafting; the transplantation of skin, bone, nerve and other tissues from a healthy region in order to repair a damaged one.
Flap surgery: Transplanting skin from a healthy area to a damaged one, together with underlying fatty tissue, blood vessels and muscle tissue.
Replantation or transplantation: the process of restitching severed hands or fingers using micro-surgery, an exceedingly finely detailed procedure requiring enormous care and performed under the microscope. Several operations repeated over a prolonged space of time may be needed in such injuries.
In many cases, thanks to surgery, injured hands can regain a considerable degree of sensation and function. But healing may take months and rehabilitation is frequently required.
Carpal Tunnel Syndrome:
The carpal tunnel is where the tendons and one of the main nerves in the wrist pass. Pressure inside the tunnel can increase after various diseases (such as rheumatoid arthritis), injuries, fluid accumulation during pregnancy, overuse and repetitive movements. This increased pressure on the nerve frequently leads to a tingling feeling accompanied by pain and impaired hand functions and numbness. The disease underlying these symptoms is known as carpal tunnel syndrome.
In some cases, placing the hand in a splint and anti-inflammatory drugs will resolve the problem. But if not, then surgery may be required.
The surgeon makes an incision from the middle of the palm as far as the wrist. The tissues placing pressure on the nerve are them cut to release the pressure. Following surgery, the hand is bandaged and placed in a splint to restrict movement, thus accelerating healing. The scar will increasingly vanish and become very hard to see.
The results of the operation to some extent depend on how long the condition has existed and how much damage the nerve has suffered. Therefore, if you think you may have carpal tunnel syndrome, it would be a good idea to see a doctor in the early stages.
Rheumatoid arthritis is a disease that affects infection of the joints and the appearance and function of the hands and other parts of the body, and that can result in severe disability. It frequently deforms the joints of the fingers and forces the fingers into a twisted position that prevents them being used.
The disabilities caused by rheumatoid arthritis can generally be treated without surgery, for example; physiotherapy can be administered or special equipment used to strengthen weakened areas. But for some patients surgery is the best solution. You must decide whether or not surgery is right for you by consulting with your surgeon and rheumatologist.
Wrists and hands can be treated by removing tissue form inflamed joints, changing the location of tendons or inserting artificial joints. Even if you do not regain full use of your hand after surgery, you can still expect a marked improvement in terms of function and appearance. It must not be forgotten that surgery does not treat the underlying disease. Rheumatoid may continue to damage your hands, and further surgery may sometimes be needed. You may also need to apply to your rheumatologist for further treatment.
Disease of the sin and subcutaneous tissue on the palm of the hand is known as Dupuytren’s contracture. Thick, scar-like tissue forms beneath the skin of the palm and progressing to the fingers can restrict movement of the fingers inward toward the palm. The disease generally develops in middle age, and though the cause is unknown, genetic transmission is one possibility.
The surgeon can separate the thickened tissue tendons and sinews and bestow great mobility on the fingers. The operation must be performed with great care, because the nerves of the hands and the fingers generally adhere tightly to this abnormal tissue. In some cases, skin graft can be used to replace thickened and deformed skin.
The results of the operation depend on the severity of the disease. There is generally a significant improvement in hand functions when combined with physiotherapy.
Congenital abnormalities of the hand are deformities present since birth, that affect hand development and cause significant problems in using the hand. With advances in surgical techniques, the majority of defects are corrected at a very early age, even in pregnancy in some patients, while in other patients correction takes place after normal hand development and function are achieved at the age of two or three.
The most common congenital hand defect is syndactyly, in which two or more fingers are joined together. Surgical treatment consists of severing the tissues joining the fingers and then applying skin grafts from elsewhere in the body to the cavities. The procedure is more complicated if bones are also joined together. Although surgery provides full movement and a close to normal appearance, there may be a slight difference in color between the grafted and other skin.
Other frequently encountered congenital defects include, short, missing or deformed fingers, inactive tendons and abnormal nerves and blood vessels. These defects can be corrected surgically in most patients.
Healing and Rehabilitation
Since the hand is a highly sensitive organ, a mild to severe pain may develop after surgery. Your surgeon will be able to relieve this with injections or drugs. The amount of time your hand will remain immobile and how quickly you will be able to resume normal activity depends on the type of surgery, its extent and how fast you heal.
Physical therapy from an experienced hand therapist may be needed for your hand to heal faster and for you to be able to use it better. Your therapist will recommend hand exercises, massage therapy, electrical nerve stimulation, splinting and special bandages. If you wish to make the maximum use of your hand you must follow your therapist’s advice to the letter.