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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