Overview of Hand Surgery

What is hand surgery?

Hand surgery is a broad term that covers many different types of procedures. Plastic surgeons who perform hand surgery seek to restore hand and finger function. But they also try to make the hand look as normal as possible, as well. Hand surgery may be done for many reasons, including:

  • Hand injuries
  • Rheumatic diseases, such as osteoarthritis and rheumatoid arthritis, that change and damage the structures in the hand
  • Degenerative changes to the structures in the hand
  • Problems or defects that are present at birth, or congenital
  • Infections

What are the different types of hand surgery?

Many different types of surgeries can be performed on the hand. It depends on the underlying cause of the problem. These procedures include:

Skin grafts

Skin grafts involve replacing or attaching skin to a part of the hand that has missing skin. This surgery is most often done for fingertip amputations or injuries. Skin grafts are done by taking a piece of healthy skin from another area of the body, called the donor site, and attaching it to the injured area.

Skin flaps

Like a skin graft, a skin flap involves taking skin from another part of the body. But this procedure uses skin that has its own blood supply. That’s because the section of skin that is used includes the underlying blood vessels, fat, and muscles. Flaps may be used when an area that is missing skin does not have a good blood supply. This may be because of the location, damage to the vessels, or extensive tissue damage.

Closed reduction and fixation

This may be used when there is a bone fracture, or broken bone, in part of the hand, including the fingers. This type of surgery realigns the broken bone and then holds it in place, or immobilizes it, while it heals. Immobilization can be done with internal fixtures, such as with wires, rods, splints, and casts.

Tendon repair

Tendons are the fibers that join muscle to bone. Tendon repair is a difficult surgery because of the structure of the tendon. Tendon injuries can occur due to infection, trauma, or sudden rupture. There are 3 types of tendon repair: primary, delayed primary, or secondary.

  • Primary repair of an acute or sudden injury is often done within 24 hours of the injury.  This is usually a direct surgery to fix the injury.
  • Delayed primary repair is usually done a few days after the injury, but while there is still an opening in the skin from the wound.
  • Secondary repairs may occur 2 to 5 weeks or longer after the injury. They may include tendon grafts. This is when tendons from other areas of the body are inserted in place of the damaged tendon. Or other more complex procedures may be used.

Nerve repairs

An injury can damage the nerves in the hand. This can cause a loss of hand function and a loss of feeling in the hand. Some nerve injuries may heal on their own. Others may require surgery. Generally, surgery is done about 3 to 6 weeks after the injury. This is the best time for nerve repairs that are linked with other more complicated injuries.

In cases where nerve damage is not linked to more complicated injuries, surgery to check the damaged nerve is usually done soon after the injury. This increases the chance of a full recovery. If the nerve is cut or severed, it may be fixed by reattaching it to the other end of the nerve. Or a nerve graft may be done. This involves replacing the damaged nerve with nerves taken from other areas of the body.

Fasciotomy

This procedure is done to help treat compartment syndrome. This painful condition occurs when there is swelling and increased pressure in a small space, or compartment, in the body. Often this is caused by an injury. This pressure can interfere with blood flow to the body tissues and destroy function. In the hand, a compartment syndrome may cause severe and increasing pain and muscle weakness. Over time, it can cause a change in color of the fingers or nailbeds.

For a fasciotomy, your doctor will make a cut or incision in your hand or arm. This decreases the pressure, lets the muscle tissue swell, and restores blood flow. Any tissue inside the area that is already damaged may be removed at this time. This procedure helps prevent any further damage and decrease in function of the affected hand.

Surgical drainage or debridement

Hand infections are very common. Treatment for hand infections may include rest, using heat, elevation, antibiotics, and surgery. If there is a sore or abscess in the hand, surgical drainage may help remove any pus. If the infection or wound is severe, debridement may be used to clean dead and contaminated tissue from the wound. This prevents further infection and helps promote healing.

Joint replacement

This type of surgery, also called arthroplasty, is used in cases of severe hand arthritis. It involves replacing a joint that has been destroyed by arthritis with an artificial joint look at here now. This artificial joint may be made of metal, plastic, silicone rubber, or your own body tissue, such as a tendon.

Replantation

This type of surgery reattaches a body part, such as a finger, hand, or toe, which has been completely cut or severed from the body. The goal is to restore as much function as possible. Replantation uses microsurgery. This is a complex type of surgery that uses tiny tools and is done under magnification using a microscope. In some severe cases, more than 1 surgery may be needed.

What are the risks of hand surgery?

Most surgery carries the risks of anesthesia and bleeding. Additional risks associated with surgery depend greatly on the type of surgery being performed and may include:

  • Infection
  • Incomplete healing
  • Loss of feeling or movement of the hand or fingers
  • Blood clots may form

When to Use Hot and Cold Therapy

Heat and cold are the two most common types of noninvasive and nonaddictive pain-relief therapies for muscle and joint pain. Which one you use depends on whether the pain is new or recurring.

In general, a new injury will cause inflammation and possibly swelling. Ice will decrease the blood flow to the injury, thereby decreasing inflammation and swelling. Pain that recurs can be treated with heat, which will bring blood to the area and promote healing.

The following information can help you learn when and how to use temperature-related therapies.

Heat therapy

What does heat therapy do?

Heat opens up blood vessels, which increases blood flow and supplies oxygen and nutrients to reduce pain in joints and relax sore muscles, ligaments, and tendons. The warmth also decreases muscle spasms and can increase range of motion. Applying superficial heat to your body can improve the flexibility of tendons and ligaments, reduce muscle spasms, and alleviate pain.

How is it applied?

Sources of heat can supply either dry or moist warmth. Dry heat sources may dry the skin. Moist heat may penetrate better. Heat can be applied by an electric or microwavable heating pad, hot water bottle, gel packs, or hot water baths. The heat should be warm, not too hot, and should be maintained at a consistent temperature, if possible. Ask your doctor or physical therapist which heat source would be best for you.

When do you use it?

Apply heat if you have stiff joints or chronic muscle and joint pain.

How can I use it safely?

Don’t apply it directly to skin. Instead, wrap the hot device in a thin towel.

Here are other tips:

  • Don’t apply heat for longer than 20 minutes, unless your doctor or physical therapist recommends longer.
  • Don’t use heat if there’s swelling. Use cold first, then heat.
  • Don’t use heat if you have poor circulation or diabetes.
  • Don’t use heat on an open wound or stitches.
  • Don’t lie down on a heating pad; you could fall asleep and burn your skin.

Cold therapy

What does cold therapy do?

Cold slows down blood flow to an injury, thereby reducing pain and swelling. Cold therapy slows circulation, reducing inflammation, muscle spasm, and pain. It should be used if the area is swollen or bruised.

How is it applied?

Cold is applied by an ice or gel pack.

When do you use it?

Any cold treatment should be used for 24 to 48 hours after an injury. Cold therapy is good for sprains, strains, bumps, and bruises that may occur in sports or lifting. Apply cold packs or ice bags to injured areas for no more than 20 minutes at a time, removing the cold for 10 minutes and reapplying it again.

How can I use it safely?

Don’t apply it for longer than 20 minutes. Also, wrap ice or ice packs in a thin towel before applying.

If in doubt as to whether to apply heat or cold to an injury, call your health care provider’s office.

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