The most common procedures in hand surgery are those done to repair injured hands, including injuries to the tendons, nerves, blood vessels, and joints, fractured bones, burns, cuts and other injuries to the skin. Modern techniques have greatly improved these procedures to restore function and appearance, even in severe injuries.
Techniques used 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. Dr. Fisher will discuss this with you at the initial consultation.
CARPAL TUNNEL SYNDROME
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 known as carpal tunnel syndrome.
In some cases, splinting of the hand and anti-inflammatory medications will relieve the problem. If this does not work, surgery may be required.
In the operation, Dr. Fisher makes an incision from the middle of the palm to the wrist. He will then cut the tissue that is pressing on the nerve in order to release the pressure. A large dressing and splint are used after surgery to restrict motion and promote healing. The scar will gradually fade and become barely visible. The results of the surgery will depend in part on how long the condition has existed and how much damage has been done to the nerve.
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.
Dr. Fisher 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.
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 be hereditary.
Surgery is the only treatment for Dupuytren’s Contracture. Dr. Fisher 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.
Congenital deformities of the hand, 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 old 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. This 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. Other common congenital defects include short, missing or deformed fingers, immobile tendons and abnormal nerves or blood vessels.