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Hand Surgery

Hand Surgery

Hand surgery is a specialized branch of plastic surgery that focuses on treating a wide range of conditions affecting the hand, wrist, and fingers. Whether caused by injury, congenital disorders, or degenerative conditions, hand surgery aims to restore function, alleviate pain, and improve the overall quality of life for patients. It is mainly surgery of hand, wrist and the peripheral nerves of upper limb.

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Hand injuries

Tendon injury

 

Tendons are cord like structures which connect the muscles of forearm to the bones in the wrist,fingers and thumb. They help in flexion and extension of wrist, fingers and thumb which is responsible for various actions of hand.

Causes of Tendon Injuries:

  • Trauma: Direct impact or force causing tendon tears or ruptures.
  • Overuse: Repetitive strain leading to chronic tendon injuries.
  • Degeneration: Aging or underlying medical conditions affecting tendon health.

Penetrating injuries with sharp objects like glass or knife are the most common cause of tendon injury and require proper evaluation and treatment. End to end repair of tendon within 24 hours of injury gives best functional result.

Tendon Repair Techniques:

  • Open Tendon Repair: Directly suturing of torn ends through a surgical incision.
  • Tendon Grafts: Using autografts or allografts to bridge larger gaps.

Post-Surgical Rehabilitation: Adhering to rehabilitation protocols is vital for successful recovery

  • Immobilization: Initial protection of the repaired tendon is done with casts, splints, or braces.
  • Physical Therapy: Gradual exercises are done to restore strength, flexibility, and function of tendon Potential Complications:
  • Stiffness and Adhesions: Scar tissue formation which can affect movement.
  • Infection: Risk of infection at the surgical site
  • Re-rupture: Careful postoperative management to prevent recurrent injuries

Nerve injury

Nerves are specialized cells that carry messages between brain and rest of body as tiny electric signals. When nerves get injured, it can lead to the loss of hand or wrist function which takes a lot of time to recover. Early nerve repair gives the best chance of recovery but depends upon the site and nature of injury.

Causes of Nerve Injuries:

  • Trauma: Accidents, falls, or injuries can lead to nerve damage.
  • Compression: Prolonged pressure on nerves, such as in carpal tunnel syndrom
  • Lacerations: Cuts or injuries that sever or damage nerves.

Nerve Repair Techniques:

  • Primary Repair:

It involves repairing the damaged nerve ends together in cases of clean cuts or lacerations.

  • Nerve Grafting:

In this technique a piece of nerve from another part of the body (autograft) or a donor source (allograft)is used to bridge larger gaps

  • Nerve Transfer:

A functional nerve is redirected to restore lost function in another area.

Nerve compressions

  • Carpal Tunnel Syndrome:

A prevalent condition caused by compression of the median nerve in the wrist, leading to pain, numbness, and weakness. Hand surgery may involve releasing the pressure on the nerve to alleviate symptoms.

  • Cubital Tunnel syndrome :

Ulnar nerve which is one of the main nerves of the arm gets compressed behind the inside part of elbow leading to numbness and tingling in the hand and fingers. If conservative methods do not improve symptoms, then surgery is required.

Finger tip injuries

The fingertip region refers to the area at the end of a finger, specifically the portion that includes the last joint, nail bed, and surrounding tissues. It is a highly sensitive and crucial part of the hand, allowing for precise touch and manipulation of objects. The fingertips contain numerous nerve endings, making them essential for tactile sensation and fine motor skills.

 

The fingertip region is vulnerable to various injuries due to its exposure and frequent use in daily activities. Common injuries in this area include cuts, lacerations, crush injuries, and nail bed injuries. The anatomy of the fingertip involves skin, soft tissues, blood vessels, nerves, bones, and the nail structure.

 

Plastic surgery plays a crucial role in the reconstruction and repair of fingertip injuries, aiming to restore both the function and aesthetics of the affected digits. Fingertip injuries can range from minor lacerations to more severe damage involving skin, soft tissues, nails, and even underlying bones. Plastic surgeons use a variety of techniques to address these injuries and promote optimal healing.

  • Reconstruction of Soft Tissues:

Plastic surgeons may perform soft tissue reconstruction to repair damaged skin, nerves, and blood vessels in the fingertip region.

Flap procedures, where adjacent healthy tissue is mobilized to cover the wound, are commonly employed to ensure adequate blood supply and promote healing.

  • Nail Bed Repair:

Injuries to the nail bed, which can result in deformities or loss of the nail, may require specialized attention from a plastic surgeon.

Procedures such as nail bed repair and reconstruction aim to restore the nail’s appearance and function.

  • Scar Revision:

Plastic surgeons address scarring resulting from fingertip injuries through scar revision techniques.

This may involve excising the existing scar tissue and employing meticulous closure methods to minimize visible scarring and improve the overall appearance.

  • Microsurgery:

In cases where the injury involves intricate structures like nerves and blood vessels, plastic surgeons may use microsurgical techniques.

Microsurgery involves using a microscope to suture tiny vessels and nerves, facilitating precise repair and restoration of function.

  • Skin Grafts and Flaps:

For larger or more complex fingertip injuries, plastic surgeons may utilize skin grafts or flaps.

Skin grafts involve transplanting skin from one area of the body to cover the injured site, while flaps involve transferring a piece of tissue with its own blood supply to the affected area.

  • Functional Rehabilitation:

Plastic surgeons work in collaboration with hand therapists to ensure proper functional rehabilitation after fingertip injuries.

Hand therapy helps patients regain strength, flexibility, and coordination, promoting optimal recovery and function.

Why to choose plastic surgeon for fingertip inuries:

Plastic surgeons strive to achieve aesthetically pleasing results, taking into account the natural contours and appearance of the fingertip.

Attention to detail in reconstructing the fingertip contributes to a more cosmetically appealing outcome.

Fingertip injuries can have a significant impact on daily activities, and plastic surgery plays a vital role in restoring both form and function. Individualized treatment plans, often involving a combination of surgical techniques and rehabilitation, are tailored to the specific needs of each patient to achieve the best possible outcomes.

Replantation

Replantation surgery is a highly specialized and intricate procedure in plastic and reconstructive surgery that involves reattaching a severed body part, such as a finger, hand, or limb, to its original site. This surgical intervention is aimed at restoring function and appearance to the affected area and is often performed in cases of traumatic amputations or severe injuries.

 

Here are key aspects of replantation surgery:

  • Patient Evaluation:

Replantation surgery is considered when a body part, typically a finger or hand, is severed due to accidents, machinery injuries, or trauma.

The patient’s overall health and the condition of the severed part are assessed to determine the feasibility of replantation.

  • Timing and Preservation:

Time is a critical factor in replantation surgery. The severed part should ideally be reattached as soon as possible to increase the chances of success.

Proper preservation of the amputated part is crucial. This may involve placing it in a cool and sterile container, such as a bag with saline or wrapped in a moist gauze, to maintain tissue viability.

  • Surgical Technique:

The surgeon carefully examines the amputation site, prepares the severed part, and reconnects the blood vessels, nerves, tendons, and other structures.

Microsurgery is often employed in replantation, using a microscope to suture blood vessels and nerves that are only a few millimeters in diameter.

  • Vascular Anastomosis:
  • Re-establishing blood flow to the reattached part is a critical step. Surgeons perform vascular anastomosis, connecting the arteries and veins to ensure proper circulation.
  • Maintaining adequate blood supply is essential for tissue viability and overall success of the replantation.
  • Nerve Repair:
  • Repairing nerves is crucial for restoring sensation and function to the replanted part. Microsurgical techniques are used to carefully reconnect nerve endings.
  • Tendon Repair:
  • Tendons control movement, and their repair is vital for restoring functionality. Surgeons meticulously suture tendons to enable coordinated movement of the replanted part.
  • Postoperative Care and Rehabilitation:
  • Following replantation surgery, patients undergo a comprehensive rehabilitation program, including physical therapy and occupational therapy.
  • Rehabilitation helps improve range of motion, strength, and functionality of the replanted part.
  • Success and Challenges:
  • The success of replantation surgery depends on various factors, including the type and extent of the injury, the condition of the amputated part, and the skill of the surgical team.
  • Challenges may include potential complications such as infection, rejection, or impaired function due to nerve damage.

Replantation surgery is a complex and highly specialized field that requires a skilled and experienced surgical team. While not all amputations are suitable for replantation, advancements in microsurgery and comprehensive rehabilitation programs have significantly improved the outcomes for those who undergo this intricate procedure. The decision to pursue replantation is often made on a case-by-case basis, considering both the physical and psychological well-being of the patient.

Trigger Finger

Trigger finger is a condition that affects the fingers, causing one or more digits to become temporarily stuck in a bent position before straightening with a snap or pop, resembling the action of pulling a trigger. This condition primarily results from inflammation of the tendon sheath, a tunnel-like structure that surrounds the tendons, facilitating smooth movement within the joints.

 

The finger’s tendons are responsible for connecting muscles to bones, and the sheath acts as a protective covering, enabling the tendons to glide smoothly during movement. When inflammation occurs, the sheath may narrow, leading to difficulty in tendon movement and causing the characteristic catching or locking associated with trigger finger.

Several factors contribute to the development of trigger finger, including repetitive hand movements, prolonged gripping, and certain medical conditions such as rheumatoid arthritis, diabetes, and carpal tunnel syndrome. It is more common in women and individuals between the ages of 40 and 60.

 

Symptoms of trigger finger may include pain and stiffness at the base of the affected finger, a popping or clicking sensation during movement, and difficulty straightening or bending the finger. In severe cases, the finger may become locked in a bent position.

 

Treatment options for trigger finger vary depending on the severity of the condition. Mild cases may benefit from rest, anti-inflammatory medications, and exercises to improve finger mobility. Splinting may be recommended to keep the affected finger in a straight position, promoting healing of the inflamed tendon sheath.

 

In more severe cases or when conservative measures fail, medical interventions such as corticosteroid injections or, in rare instances, surgery may be considered. Corticosteroid injections can help reduce inflammation, providing relief from symptoms. Surgical procedures involve releasing the constricted sheath, allowing the tendon to move freely.

Dupuytren's Contracture:

Dupuytren’s contracture is a hand condition that affects the connective tissue beneath the skin in the palm and fingers. It is characterized by the formation of thick, fibrous tissue bands (nodules) within the palm. Over time, these bands can tighten and pull the fingers into a bent or curled position. The exact cause of Dupuytren’s contracture is not fully understood, but there are several factors associated with its development. The condition is more prevalent in individuals of Northern European descent and is often hereditary. Other risk factors include advancing age, male gender, smoking, and certain medical conditions such as diabetes and alcoholism.

 

The initial signs of Dupuytren’s contracture typically involve the development of small, painless nodules or lumps within the palm. As the condition progresses, these nodules may extend into thick cords that can limit the flexibility of the affected fingers. The ring and little fingers are most commonly affected, but any digit can be involved.

 

The progression of Dupuytren’s contracture varies from person to person. In some cases, the condition may progress slowly and cause minimal disruption to hand function, while in others, it can progress more rapidly, leading to significant contractures and functional limitations. Treatment options for Dupuytren’s contracture depend on the severity of the condition. In mild cases with minimal symptoms, observation and regular monitoring may be sufficient. For more advanced cases, interventions such as needle aponeurotomy or collagenase injections may be considered to break up the tight cords and improve finger mobility.

 

In cases where the contracture is severe and affects daily activities, surgical procedures like fasciotomy or fasciectomy may be recommended. These surgeries involve cutting or removing the thickened bands of tissue to release the affected fingers and restore hand function. Hand therapy and rehabilitation are often essential components of the post-surgical recovery process.

Tumours /Vascular malformations

Hand tumors can encompass a variety of growths or masses that develop in the structures of the hand, including the bones, soft tissues, nerves, and blood vessels. Tumors in the hand can be benign (non-cancerous) or malignant (cancerous), and they may originate from different cell types within the hand.

  • Ganglion Cysts:
  • Type: Benign
  • Ganglion cysts are the most common type of hand tumor. They are non-cancerous fluid-filled sacs that often develop near joints or tendons, causing a visible lump.
  • While they are usually painless, they may cause discomfort or restrict movement, and aspiration or surgical removal may be considered for symptomatic relief.
  • Lipomas:
  • Type: Benign
  • Lipomas are slow-growing, soft tissue tumors composed of fat cells. They are generally harmless and painless.
  • Surgical excision may be performed if the lipoma causes discomfort, affects hand function, or for cosmetic reasons.
  • Glomus Tumors:
  • Type: Usually benign, but can be malignant in rare cases
  • Glomus tumors arise from the glomus body, a small structure involved in temperature regulation in the fingers. They can cause severe pain, sensitivity to cold, and nail changes.
  • Treatment often involves surgical removal, and malignant cases may require more extensive intervention.
  • Fibromas:
  • Type: Benign
  • Fibromas are tumors that develop in the connective tissue of the hand. They can affect the palmar fascia, leading to conditions like Dupuytren's contracture.
  • Treatment may involve surgery to release or remove the affected tissue.
  • Malignant Tumors:
  • Type: Cancerous
  • Malignant tumors in the hand can include sarcomas, carcinomas, or metastases from other parts of the body.
  • Treatment typically involves surgical removal, and additional therapies such as radiation or chemotherapy may be necessary depending on the type and stage of cancer.
  • Enchondromas:
  • Type: Benign
  • Enchondromas are benign tumors that develop in the bones of the hand. They are composed of cartilage.
  • Treatment may be required if the tumor causes pain, deformity, or poses a risk of fracture.
  • Neuromas:
  • Type: Benign
  • Neuromas are non-cancerous growths of nerve tissue. In the hand, they can result from nerve injuries or amputations.
  • Surgical excision or other interventions may be considered to alleviate pain and improve function.

Diagnosing hand tumors involves a combination of clinical evaluation, imaging studies (such as X-rays, MRI, or ultrasound), and sometimes biopsy. Treatment decisions depend on the type of tumor, its location, and the symptoms it produces. Early detection and consultation with a hand specialist are crucial for proper diagnosis and management.

Vascular malformations

Vascular malformations in the hand refer to abnormal, tangled networks of blood vessels that develop in the soft tissues of the hand. These malformations are considered congenital, meaning they are present at birth, and they result from errors in the development of blood vessels during fetal development. Vascular malformations can vary widely in size, appearance, and symptoms, and they may be categorized into different types based on the type of blood vessels involved.

 

The types of vascular malformations include:

  • Capillary Malformations (Port-Wine Stains)
  • Venous Malformations
  • Arteriovenous Malformations (AVMs
  • Lymphatic malformations

The symptoms and severity of vascular malformations in the hand can vary, and management options depend on the specific type and extent of the malformation. Treatment may include conservative measures such as compression therapy, laser therapy for port-wine stains, or more invasive interventions such as embolization, sclerotherapy, or surgical removal for larger or symptomatic malformations.

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