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.
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
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
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 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 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.