Definition and Overview

A hand surgery is a surgical procedure performed in any parts of the hand including the skin, tendons, joints, bones, cartilages, and nerves. To a certain extent, it also covers the wrists, forearms, elbows, and shoulders.

The hand plays a huge role in our daily activities. It is responsible for increasing our mobility, productivity, and efficiency. It also enhances our sensory experience.

However, there are three possible scenarios that can cause damage to the hands, which may then require surgery and these are:

  • Injury – Injury or trauma can result in broken fingers, torn ligaments or tendons, strained shoulder, or dislocated elbow. It may also cause the amputation of any part or all of the hand, which may demand a surgical procedure known as replantation.

  • Condition – As the hand is composed of many different complex parts, it’s also vulnerable to a variety of diseases including but not limited to arthritis, Carpal tunnel syndrome, tennis elbow, and tendonitis.

  • Congenital defect – Certain conditions that affect the hands may develop even before the baby is born due to chromosomal abnormalities or wrong division of cells.

Who Needs It and Expected Results

Hand surgeries are recommended if:

  • the problem prevents the patient from performing his daily activities such as holding or lifting objects
  • the pain is unbearable
  • it's the only option to avoid complications
  • the patient has been diagnosed with a chronic condition such as arthritis
  • the injuries cannot be treated with therapy alone
  • the hand has become infected by virus, bacteria, or disease (such as neuropathy caused by complications of diabetes, or skin cancer)
  • there are huge burn scars that affect the function of the hand
  • there is a fracture

Regardless of the type of the hand surgical procedure, all hand surgeries carry a certain degree of pain and swelling at least within the next 24 or 48 hours. Although not all surgeries will require an admission to the hospital, this may be suggested if the operation is considered high risk, sensitive, or serious. This allows the doctors to monitor the patient’s initial recovery and vital signs.

One should also expect immobilization for a certain period to allow the hand to heal faster. A splint, bandage, or a certain type of garment may have to be used for days or even months. At first, the patient’s movement will be severely limited, which may cause frustration, but over time, the patient should be able to regain all or at least the basic functions of the hand.

How Is It Done?

Since there are many conditions that can affect the hand, the first step is to conduct medical tests to diagnose the condition, which is then used in identifying the best course of treatment. The doctor may do it through a physical exam, especially when it’s an injury. If the doctor cannot immediately determine the exact condition or the severity of the injury, additional tests such as imaging exams will be required.

Hand surgeons, meanwhile, are health providers that specialize in this procedure. Unlike a typical hand specialist such as an orthopedist, a hand surgeon has additional training and technical skill to operate not just the hand but also other parts of the body connected to it.

Common procedures performed on the hand are:

  • Arthroscopy – This is a minimally invasive surgery performed on the elbows or wrists. In this procedure, the patient is provided with anesthetics before a small incision is made in the area. Then, a thin probe with a camera at the tip is inserted into the incision. The camera then allows the surgeon to correctly identify the areas to be treated using small surgical tools. Since the incisions are small, recovery time is often short.

  • Grafting and Transfer – Grafting and transfer refers to the process of moving a certain part of the body from the donor to the recipient site. Grafting often refers to the skin and is thus a common option in dealing with prominent scars caused by disease or injury. A healthy skin is removed from the donor site and connected to the hand. A transfer, meanwhile, means physically removing, say, a healthy tendon, from the hand as a replacement of the worn or injured part.

  • Replantation – Replantation is required when the hand or a part of it has been detached from the body, usually due to an accident or injury. To do this, the amputated part should not be in the necrotic stage, which means the tissue should not be dead. The procedure requires the surgeons to reconnect the blood vessels and nerves correctly to restore function.

  • Skin Flap – A skin flap is the variation of skin graft. The major difference between the two is that the skin flap has a healthy blood supply. This simply means that when it is removed for transplantation, the surgeon must bring along the blood vessels, muscles, and fat. This procedure is highly recommended when the tissue has been severely damaged or the blood supply has been cut off.

  • Surgical drainage – If the hand has been infected because of a disease or an injury, it may not only swell but also gather pus. To remove the pus, surgical drainage is performed.

Risks and Complications

Like in any surgery, the possible complications of a hand surgery are bleeding and infection, although between the two, the latter is more threatening. It’s also possible that the surgery may result in nerve damage, which may reduce the mobility of the fingers or the loss of sensation. Sometimes, too, more complications set in as the patient prevents complete healing. This can be out of frustration over the lack of mobility after surgery.

References:

  • http://www.assh.org/handcare/About-Hand-Surgery
  • http://www.hopkinsmedicine.org/healthlibrary/conditions/plasticsurgery/overviewofhandsurgery_85,P01130/
  • Webb CW. Metacarpal fractures. In: Eiff MP, Hatch RL, eds. Fracture Management for Primary Care. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 4.
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