Dramatic advances have been made in recent years in treating patients with disorders 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 microsurgery. I personally have dedicated an extra year of training to perfecting Microsurgical, and Hand Surgery skills.
If you're considering hand surgery, a consultation with a Plastic Surgeon is a good place to start. I will examine you, discuss the possible methods of treatment for your problem, and let you know if surgery is warranted, and if it needs to be done soon to preserve the strength in your hand. I will discuss the procedure in detail, including where the surgery will be performed, 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.
Carpal Tunnel Syndrome Surgery Using Mini-Incision Microsurgery Technique
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 called 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.
In the operation, I use a very small incision in the palm of the hand near the wrist. I use a state of the art microscope (used at major University Hospitals) to release pressure on the nerve. A long acting block is placed in the wound to provide a "virtually pain free" first 24 hours. A large dressing and splint are used after surgery to restrict motion, and promote healing. I personally see to the early physical therapy, getting you started to a full recovery, all in one office if possible. The scar will gradually fade and become barely visible.
The signs and symptoms of Carpal Tunnel Syndrome include pain, tingling, numbness (in the thumb, index, middle, and thumb side of the ring fingers), as well as diminished grip strength. Losing strength in you hand suggests an urgent need to see a Hand Surgeon and begin your evaluation. Should you experience any weakness, you should see a specialist as soon as possible, or you may have a permanent impairment. .
The most common procedures in hand surgery are 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.
Among the techniques now used by plastic surgeons are:
Grafting - the transfer of skin, bone, nerves, or other tissue from a healthy part of the body to repair the injured part;
Flap surgery - moving the skin along with its underlying fat, blood vessels, and muscle from a healthy part of the body to the injured site;
Replantation or transplantation - restoring accidentally amputated fingers or hands using microsurgery, an extremely precise and delicate surgery performed under magnification
Some injuries may require several operations over an extended period of time. In many cases, surgery can restore a significant degree of feeling and function to injured hands. However, recovery may take months, and a period of hand therapy will most often be needed.
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.
Surgeons can repair or reconstruct almost any area of the hand or wrist by removing tissue from inflamed joints, repositioning tendons, or implanting artificial joints. While your hand may not regain its full use, you can generally expect a significant improvement in function and appearance. Still, it's important to remember that surgical repair doesn't eliminate the underlying disease. Rheumatoid arthritis can continue to cause damage to your hand, sometimes requiring further surgery, and you'll still need to see your rheumatologist for continuing care.
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.
The results of the surgery will depend on the severity of the condition. You can usually expect significant improvement in function, particularly after physical therapy, and a thin, fairly inconspicuous scar.
Congential 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.
Since the hand is a very sensitive part of the body, you may have mild to severe pain following surgery. Your surgeon can prescribe medication to make you more comfortable. How long your hand must remain immobilized and how quickly you resume your normal activities depends on the type and extent of surgery and how fast you heal.