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 & Hand Surgeon-specialists whose major interest is improving both function and appearance.
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:
- Skin/Tendon/Nerve repair
- 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 (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.
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 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.
- Hand Tumours
- Inclusion cysts
- Soft tissue tumours
- Tendon Transfer Surgery
What is Tendon Transfer Surgery?
Tendon transfer surgery is a type of hand surgery that is performed in order to improve lost hand function. A functioning tendon is shifted from its original attachment to a new one to restore the action that has been lost.
Who needs Tendon Transfer Surgery?
Many different conditions can be treated by tendon transfer surgery. Tendon transfer surgery is necessary when a certain muscle function is lost because of a nerve injury or when a muscle has ruptured or in disorders of the nervous system or in congenital absence of muscles in children. Common nerve injuries that are treated with tendon transfer surgery are spinal cord, radial nerve, ulnar nerve, or median nerve injury. Common nervous system disorders treated with tendon transfer surgery are cerebral palsy, stroke, traumatic brain injuries, and spinal muscle atrophy. Common congenital conditions treated this way include hypoplastic thumbs and birth brachial plexopathy.
What happens during Tendon Transfer Surgery?
Below the elbow, there are over forty muscles. Each different muscle has a different function. For example, there are 9 muscles that move the thumb. Each muscle has a starting point (origin), and tapers down from its muscle belly into a tendon that then attaches onto bone (insertion) in a specific place; when the muscle fires (contracts), it causes a certain motion (action). During tendon transfer surgery, the origin of the muscle is left in place; the nerve supply and blood supply to the muscle is left in place. The tendon insertion onto bone is detached and re-sewn into a different place. It can be sewn into a different bone, or it can be sewn into a different tendon. After its insertion has been moved, when the muscle fires, it will produce a different action, depending on where it has been inserted.
What are the risks to Tendon Transfer Surgery?
All surgery has some risk, although those risks may be small. All surgeries produce a surgical scar. Surgical incisions may develop infection. All surgeries require the use of anesthesia, and will require a complete history and physical examination by your primary care physician to determine if you have medical risks associated with anesthesia. Evaluation by the anesthesiologist will help outline your risks and options. When a tendon is transferred and sewn into another position, the tendon transfer will need a period of time to heal, usually about one to two months. A splint or cast may be used, followed by therapy to teach you the new tendon function. Finally, exercises will be needed to strengthen the muscle after your hand surgeon feels the tendon transfer has sufficiently healed.
You will need to follow post-operative instructions. Movement too early can lead to rupture of the tendon transfer. Movement too late can lead to excessive scarring of the tendon with resultant stiffness. Discussion of your individual case with your hand surgeon will help you further understand the risks and benefits associated with tendon transfer surgery.
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.