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Hand Surgery

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.

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.

The techniques most commonly used grafting - the transfer of skin, bone, nerve or other tissue from a healthy part of the body to repair the injured part; flap surgery and replantation of amputated hand or digit. Surgery can restore a significant degree of feeling and function to the injured hand.

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, and 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.

If splinting of the hand and anti-inflammatory medications do not relieve the problem, surgery may be required.

In the operation, an incision is made from the middle of the palm to the wrist and a band of ligament causing the pressure on the nerve is divided. A large dressing and splint are used after surgery to restrict motion and promote healing. The scar will gradually fade and become barely visible.

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.

RECOVERY AND REHABILITATION

Since the hand is a very sensitive part of the body, you may have mild to severe pain following surgery that can be relieved with medication. 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, you may require 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.

 
 

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