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Hand surgery and your plastic surgeon
 

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 surgeons-specialists whose major interest is improving both function and appearance.

Plastic surgeons undergo intensive training in hand surgery, and they (along with orthopedic surgeons and general surgeons) treat patients with a wide range of hand problems.

This information is designed to give you a basic understanding of the most common hand problems-what they are, what plastic surgeons can do for them, and the results you can expect. It can't answer all of your questions, since each problem is unique and a great deal depends on your individual circumstances. Please be sure to ask your doctor if there is anything about the procedure you don't understand.


IF YOU'RE CONSIDERING HAND SURGERY
If you're considering hand surgery, a consultation with a plastic surgeon is a good place to start. The surgeon will examine you, discuss the possible methods of treatment for your problem, and let you know if surgery is warranted. If it is, the surgeon will discuss the procedure in detail, including where the surgery will be performed (in the surgeon's office, an outpatient surgery center, or a hospital), the anesthesia and surgical techniques that will be used, possible risks and complications, the recovery and rehabilitation period, and the probable outcome in terms of function and appearance.
Don't hesitate to ask your surgeon any questions you may have during the initial consultation-including any concerns you have about the recommended treatment and the costs involved.


HAND INJURIES
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. Modern techniques have greatly improved the surgeon's ability to restore function and appearance, even in severe injuries.

 

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.

 


RHEUMATOID ARTHRITIS
Rheumatoid arthritis, an inflammation of the joints, is a disabling disease that can affect the appearance and the function of the hands and other parts of the body. It often deforms finger joints and forces the fingers into a bent position that hampers movement.


Disabilities caused by rheumatoid arthritis can often be managed without surgery-for example, by wearing special splints or using physical therapy to strengthen weakened areas. For some patients, however, surgery offers the best solution. Whether or not to have surgery is a decision you should make in consultation with your surgeon and your rheumatologist.

 


DUPUYTREN'S CONTRACTURE
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.

 


CONGENITAL DEFECTS
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.

 

 

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