Hand Surgery

Hands help us to eat, dress, write, earn a living, create art and do many other activities. To do these tasks, our hands require sensation and movement, such as joint motion, tendon gliding and muscle contraction.

Hand surgery involves a vast range of surgery on the hand. Plastic surgeon who does hand surgery not only ensures the function of the hand, but also makes efforts to maximize the cosmetic appearance of the hand.

Surgery on the hand can be performed for the following below reasons but not limited.

Some kind of trauma to the hand Rheumatic arthritis leading to changes in the structure of hand Congenital (present at birth) deformities Infections

Types of Hand Surgeries

There are different types of surgeries depending upon the condition and underlying cause of the problem. These procedures include:

Tendon Injury

Tendons repair surgery is to repair damaged or torn tendons. Tendons are tissues that connect muscle to the bone. Tendon injuries might occur because of reasons like infection, trauma, or sudden rupture.

Nerve Injury

Any sort of injury too can damage the nerves in the hand. This can cause a loss of hand function and a loss of sensation in the hand. Some nerve injuries may heal on their own. Others may require surgery. Generally it takes 3-6 weeks’ time for nerves to repair and therefore surgery is done post automatic repair for effective results.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is the most common nerve compression syndrome in the upper limb. It is predisposed by trauma, Osteoarthritis, pregnancy, diabetes and thyrotoxicosis. Symptoms include pain, numbness and paraesthesia of the hand specially night pain and waking is common. Pain may radiate to shoulder and neck. Clumsiness and weakness results dropping of items. Relief is usually achieved by shaking the hand and placing it in a dependent position.

Treatment

Surgical decompression of the carpal tunnel and Neurolysis of the median nerve is very effective and improve the condition dramatically.

Recovery

Patient could get back to work from the next day taking precaution not to carry heavy wait for a week or so.

Glomus Tumor

A Glomus Tumor is rare, usually benign, soft tissue neoplasm. The glomus apparatus (or glomus body) is a part of the dermal layer of the skin and is thought to aid in temperature regulation. When exposed to cold temperatures, the glomus body moves blood away from the skin’s surface to reduce heat loss. While they are located all over the body, glomus apparati are found in higher concentrations in the fingers and toes. Abnormal growth of a glomus body results in Glomus Tumors.

Glomus Tumors usually occur in people 20 to 50 years of age but are more frequent in young adults. More common in women, 70% of Glomus Tumors present in the hand with the clear majority occurring underneath the nail bed. Most of the nodules are solitary but can occur in clusters. Glomus Tumors represent 1 to 5% of all soft tissue tumors in the hand and fingers.

Procedure

Surgical excision of the tumor is the only treatment modality. During a 15-minute outpatient procedure, the nail is removed, an incision is made into the nail bed exposing the tumor, and the tumor is removed. The site is sutured closed and bandaged.

Recovery

The symptoms of pain and cold intolerance are immediately relieved, and the nail will grow back to a normal appearance in 3 to 4 months.

Dorsal Wrist Ganglion Surgery

A ganglion cyst is a fluid-filled noncancerous lump that usually develops in the wrist or hand. But some occur in the ankles or feet.

When a ganglion cyst presses on a nerve it can be painful. And depending on its location, a ganglion cyst may restrict movement.

Some cysts do not need treatment, but others must be surgically removed. During a ganglion cyst removal, a doctor removes the cyst capsule or stalk to completely remove the cyst.

Procedure

Ganglion cyst removal is usually an outpatient procedure and may be performed under local or general anesthesia.

Before surgery, your doctor may draw a line above the cyst to mark the incision location. During the surgery, your doctor numbs the treatment area and cuts along the line with a scalpel. The doctor then identifies the cyst and cuts it out along with its capsule or stalk. Once the cyst is removed, your doctor stitches the opening to let the skin heal.

Recovery

After your surgery, rest as much as you can for a few days. This will encourage the site of your cyst removal to heal. Limit movement of your hand and wrist to minimize pain and avoid irritation of the removal site.

Dupuytren’s Disease

Dupuytren’s disease is a condition of unknown aetiology characterised by con- traction of the palmar or digital fascia. Which gradually results in ability to open the fingers completely. It is common in patients with diabetes, liver disease, epilepsy and TB. It may be associated with a high alcohol intake and local trauma. In cases of strong family history The condition is usually severe.

Treatment

Surgery is required when flexion at finger base is more than 20–30°, any contracture of finger joints or Painful, Rapidly progressive disease. Limited regional fasciectomy is the treatment of choice

Recovery

Patients may get back to their work in a week or so, Sometimes patients may require post-operative care following surgery in form of limb elevation, splints, physiotherapy and night Splint age is also required for a few months.

Syndactyly Surgery

Surgery to correct syndactyly, in which two or more fingers are fused, resulting in webbed fingers, is typically performed after a child is about one year old to lessen the risks posed by anesthesia and give the surgeon larger anatomic structures to work with during surgery.

Procedure

During this procedure, which is called syndactyly release, an orthopedic surgeon makes zigzag incisions between the digits to divide them. The zigzag approach gives the surgeon pointed flaps of skin to wrap around each digit. This method helps prevent scars that could constrict movement later. Sometimes a small piece of skin from another area of the body, called a skin graft, may be needed to cover the space between the fingers after they are separated.

When the pinky finger or thumb is involved, the operation is done earlier, often when a child is around six months old. This avoids growth problems with the adjacent ring or index finger, because the thumb and pinky finger are shorter than their neighboring digits.

Camptodactyly

Camptodactyly is a condition in which a finger will not straighten completely. The middle joint of the finger does not work normally. This is called a flexion contracture. Camptodactyly may happen in any of the fingers, but it happens most often in the pinky finger.

Procedure

The surgery will be done in the operating room under general anesthesia (the child is put to sleep).

Small cuts are made in the fingers to get to the bone.

A cut in the bone is made to straighten the bones of the fingers.

The fingers are put in the correct position. Small pins, wires or screws are used to hold the bone straight.

After the surgery is done, if there was a cut made in the skin, it is then closed with stitches.

Trigger Thumb

A trigger finger or trigger thumb occurs when the tendons that flex the finger enlarge and aren’t able to slide smoothly within the tunnel the tendons pass through. This causes your child’s finger or thumb to pop or click when she tries to straighten it.

The condition is often painless, but your child may also experience pain when straightening her digits and her finger may get stuck in a crooked or bent position.

Procedure

Surgery to correct trigger thumb is usually performed when a child is between 1 and 3 years of age. In this procedure, your child’s surgeon will release the tendon from the tendon sheath where it is catching, allowing the tendon to glide more smoothly.

Clasped Thumb

The congenital clasped thumb is also known as thumb-in-palm. It describes the position of the thumb being fixed in a bent position across the palm of the hand and that the thumb can only be straightened using another hand, i.e. the child cannot straighten the thumb using their own muscles.

It occurs due to either a weakness or an absence of the tendon-muscle units that straighten the thumb and is often seen in both hands.

Procedure

If there is no improvement with massage, stretches, and splinting over a three to six month period then surgery may be suggested.

Polydactyly

Polydactyly is a condition where a person is born with extra fingers or toes on one or both of their hands and feet. It may be small finger duplication, polydactyly of thumb or very rarely central one.

Procedure

Removing less functional finger and reconstructing the dominant one.

Clinodactyly

Clinodactyly is the clinical term for an abnormally bent or curved finger, usually caused by abnormal development of the small bones of that finger. It could also stem from the growth plate of the hand having an atypical shape, or the bones might be growing in an atypical direction. Diagnosis involves imaging tests and treatment, in severe cases, may call for surgery.

Procedure

Surgical procedures typically involve making a cut in the bone, correcting the deformity and stabilizing the finger until the bone and soft tissue are healed. While surgery is usually successful in correcting the curvature, there is a risk for recurrence and need for future surgery.

Replantation

In this procedure accidentally amputated fingers or hands using microsurgery are restored. It is an extremely precise and delicate surgery performed under magnification.