Hand Surgery

The term "hand surgery" is broad and covers a wide range of surgeries.  Hand surgery is performed by plastic surgeons with the goal of regaining finger and hand function. However, hand surgeons also work to restore the hand's natural appearance. 

There are a few reasons to undergo hand reconstruction surgery. Hand injuries, rheumatic diseases that affect and harm the hand's structures, such as osteoarthritis and rheumatoid arthritis, degenerative changes to the hand's structures, congenital or congenital hand problems or defects, and hand infections are among the conditions for which people have undergone hand surgery operations. 

Anesthesia is used for the majority of hand surgeries. Anesthesia and bleeding risks  are present during surgery. Infection, inadequate healing, loss of feeling or movement in the hand or fingers, blood clots, and other risks related to surgery can occur. These risks rely primarily on the type of surgery performed. (1)

Definition and Overview

Hand surgery is a special subspecialty for orthopedic, plastic, and general surgeons. Hand surgery may be necessary for a number of reasons, including the treatment of long-term conditions that affect the hand as well as the treatment of hand injuries or infections. Surgery can be performed on different parts of the hand and modification of bones or soft tissues in the hand may be advised. General surgeons, orthopedic surgeons, and plastic surgeons frequently perform hand surgery. The surgery being performed differs based on the condition it is intended to treat. Some procedures are carried out while the patient is awake and under local anesthetic. (2) 

Procedures

Numerous surgical procedures can be carried out, depending on what the underlying cause of the problem is. 

• Skin grafts

Skin grafts for the hand include putting in or removing the skin on the part of the hand that is deficient in the skin. This procedure is typically used to treat injuries or amputated fingertips. To create a skin transplant, healthy skin from the donor area of the body is removed and adhered to the wounded area.

• Skin flaps

Skin flaps for the hand require the removal of skin from another area of the body, much like a skin graft. However, this treatment makes use of skin with a blood supply of its own. The reason for this is that the area of skin that is employed has the underlying blood arteries, fat, and muscle. When a skin-deficient area lacks a strong blood supply, flaps may be employed. This can be the result of the location, vascular injury, or severe tissue damage.

• Closed reduction and fixation

When there is a bone fracture or fracture in a portion of the hand, including the fingers, closed reduction and fixation may be employed. The broken bone is realigned with this procedure, after which it is held or immobilized until it heals. Internal fixtures including wires, rods, splints, and plasters can be used for fixation.

• Tendon repair

Tendons are fibers that link muscle with bone. Trauma, infection, or a sudden rupture are all possible causes of tendon injury. Primary, delayed primary and secondary tendon repairs are the three different types of tendon repair.

• Nerve repairs

The nerves in the hand can become damaged by trauma or injury. It may result in diminished hand sensation and diminished hand function. The procedure is typically performed 3 to 6 weeks following the accident. It is the best time for nerve repairs connected with other more complex injuries.

• Fasciotomy

The main objective of fasciotomy surgery is to treat compartment syndrome. When there is swelling and increased pressure in a confined area or compartment of the body, this uncomfortable condition develops. Function may be hampered and blood flow to body tissues may be blocked by this pressure.

• Surgical drainage or debridement

Rest, heat, altitude, antibiotics, and surgery are all possible treatments for hand infections. If the hand has a wound or abscess, surgical drainage may assist to remove any pus. Debridement may be done to remove dead and contaminated tissue from the wound if the infection or wound is severe.

• Joint replacement 

In cases of severe hand arthritis, this kind of surgery, also known as arthroplasty, is performed. It entails using an artificial joint to replace a joint that has been ruined by arthritis. This artificial joint might be made of metal, plastic, silicone rubber, or the patient's own body tissue, such as a tendon.

• Replantation

A finger, finger, or toe can be reattached with this sort of surgery if it has been fully severed or separated from the body. In replantation, microsurgery is used. This type of complicated surgery is carried out utilizing a microscope and small equipment while being magnified. (3)

Candidates

Patients with some common discomforts and conditions may indicate the need for hand surgery. These include

• pain in fingers, hand, wrist, elbow, or arm, or other upper-extremity-related concerns,
• conditions affecting the hand, wrist, or forearm,
• have experienced traumatic injuries to the hand. (4)

Risks and Side Effects

The majority of hand surgeries carry the risks of anesthesia and bleeding. Additional risks connected with surgery vary significantly depending on the procedure and may include:

• infection
• incomplete recovery
• loss of feeling or movement in the hand or fingers
• blood clots  (5)

Post-Procedure and Follow-up

For a good recovery, ideal recovery, and long-term outcomes following hand surgery, it is essential to have post-procedure and follow-up treatment. Depending on the type of hand surgery performed, the severity of the condition, and the demands of the particular patient, the post-procedure and follow-up process will be different. (6)

Recovery

The type of surgery done and the underlying cause of the hand disease have a significant impact on how well a patient recovers after hand surgery. Repeat operations are occasionally required. The hand is a delicate and complicated aspect of human life. After several hand procedures, the pain of all intensities is to be anticipated. Painkillers may be administered to ease discomfort.

Results

The aim of the operations is to bring the hand back to its former function as much as possible. In order to achieve this, it is very important to follow all the instructions given to the patient by the doctor and other caregivers after the surgery.