Plastic surgery of the hand

Hand lesions can affect every person’s quality of life as the upper limb functionality is providing a normal daily routine. Although not very common, hand lesions can be treated by specific surgical procedures, meant to restore endangered functions as a result of trauma or congenital anomalies.

Informations about the medical procedure

Plastic surgeons are the ones in charge of this area, where techniques from general surgery are combined with the ones of microsurgery, vascular surgery and orthopedic surgery. Specific interventions in this field can treat the hand, the wrist and the peripheral nerves.

The upper limb functionality is extremely important for each of us, therefore it requires a thorough practical knowledge, accuracy and clinical thinking.

With regard to the hand, the most common conditions are:

The carpal tunnel syndrome is a condition caused by pressure on the median nerve in the wrist called the carpal tunnel in medical language. Typically, patients accuse a feeling of numbness, tingling or even pain of the fingers at night or in the morning, when they wake up. When the symptoms are acute, it is necessary to decompress (pressure reduction) the nerve, and this can be achieved by sectioning the ligament forming the top of the carpal tunnel of the palmar side of the hand. Postoperative, differing from patient to patient, numbness or tingling may disappear more slowly or quickly.

The cubital tunnel syndrome is a condition caused by pressure on the ulnar nerve at the elbow, which usually causes pain, tingling or loss of sensitivity. To meliorate symptoms, it is necessary, in a first phase, to avoid actions that generate pressure on the nerves, and if conservative treatment fails, the doctor will recommend surgery. The procedure involves releasing the nerve, placing it in front of the elbow and sometimes removing a portion of the elbow bone.

Dupuytren’s disease occurs by an abnormal thickening of the superficial palmar aponeurosis, just below the skin, a process that expands in the hand, but may extend to fingers. Appearance of nodules and depressions in the palm limits the finger movements, bending them in an abnormal position, therefore, in cases where this disease is advanced, surgery is necessary. Depending on the severity of the condition and the age of the patient, the surgeon will choose the appropriate procedure to reduce the hand deformity and improve its functionality.

Tendon surgery: upper limb injuries may affect tendons, which assure the bending movements (flexion) or stretching of the fingers (extension) and wrist. After such a trauma, patients mostly experience difficulties in aligning the joints. In total lesions, functionality of the tendons and fingers is seriously affected, therefore, their reactivation requires surgical treatment.

Fractures of the hand, in addition to the pain they cause, are often affecting the movements and may induce visible deformations. Certain types of fractures require surgery; for example, when the joint is affected or the fracture is not stable after its orthopedic reduction. In these cases, for bone stabilization, hand surgery is resorted to.

Surgery of tumor formations. In the hand or the fist diverse growths, called tumors in medical terms, may appear. Most tumors located in these areas are, however, not malignant or cancerous, but they need to be surgically removed in order to eliminate the symptoms of compression of the noble tissues (nerves, vessels, tendons) as well as to prevent any tumorous changes of precancerous conditions or damage to nearby structures.

The most common tumors are located in the hand and wrists are the synovial cyst, the giant cell tumor of the tendon sheath and the epidermal inclusion cyst. In addition, in the hand, other structures may occur, but less usual, such as lipomas (fatty tumors), neurinoma (nerve tumors), nerve sheath tumors, fibromata and dermal glomus tumors.

Due to the fact that the majority of tumors located in the hand and wrist are benign, patients choose not to operate, although surgical excision is, in fact, the treatment that prevents regression of the disease. Over time, conditions of this type can withstand changes (increase in dimension of the tumor, skin pigmentation, etc.) or attack other structures located in the vicinity which, for example, can cause pain and numbness of limbs. These situations lead, in the end, to a surgical treatment.

Even if tissue biopsy denied the possibility of a cancer, it is recommended that the patient takes into account the risks they expose to by not exciding tumor formations, which may affect the limb function over the years.

Consultation

In case of hand disorders, doctor Aşchilian will examine the patient and, depending on certain factors (mobility, sensitivity, strength on the fingers etc) will decide what is the procedure they will undergo. At the same time he will be expose the risks associated to the surgery and the possible limitations. In order to achieve a complete picture, the patient will discuss with the doctor the history of the condition and will provide all medical records.

Duration

Varies from 30 minutes to two hours, depending on the severity of the case and the complexity of the operation.

Anesthesia

More types of anesthesia are used in hand surgery: local, regional or general, depending on the nature and duration of the intervention. After assessing the health status of the patient and his preferences, the surgeon will choose the most suitable method of anesthesia.

Hospitalization

If the surgery was performed under general anesthesia, the patient remains hospitalized for one day.

Side effects and surgical risks

After the intervention, swelling and stiffness of the operated area (due to immobilization) are possible but also the occurrence of ecchymosis. The pain can be lightened by using analgesics. Although rare, postoperative bleedings may occur, sensory disturbance or unfavorable scarring of the area.

After surgery advice

As smoking slows the healing process, one of the medical recommendations aims at quitting cigarettes for a specified period of time. The patient will be informed by the surgeon when they can start physical therapy and physiotherapy to restore the hand function. Patients should be aware that the final result depends largely on how the doctor's instructions are followed.

Contraindications

Movements should be resumed postoperatively when your doctor recommends it, in order to eliminate the risk of the condition to relapse.

Recovery

After surgery and if necessary, the patient's hand will be fixed in a splint. Within the range indicated by the surgeon, they will start to do physical therapy exercises in order to restore the hand function. It is very important that the doctor's instructions shall be followed strictly, otherwise there is a risk of reinjuring. After two weeks at most, the stitches will fall by themselves, as they are resorbable material, but the end result may be evaluated at 6-12 months after surgery.