Hand surgery refers to surgery of the hand, wrists, and peripheral nerves of the upper limb. This also covers reconstructive surgery to enhance the function of the upper limb. Hand surgery may be practiced by graduates of orthopaedic surgery, general surgery, and plastic surgery.
Paediatric hand specialists or surgeons specialize in acquired and congenital shoulder, arm, and hand conditions of children. They assume leadership of Paediatric Hand Team. The surgeon will assess the functioning of the child’s hand. He will discuss options of surgical interventions if suitable and refer to orthotic/prosthetic or therapeutic interventions to optimize the child’s hand function.
Hand surgery may be performed for the following conditions:
- Congenital defects of the hand
- Injuries to hand and wrist
- Rheumatic diseases like arthritis
- Degeneration in the structure of the hand
- Disorders of nerve compression (Cubital Tunnel Syndrome and Carpal Tunnel Syndrome)
- Dupuytren’s contracture
- Hand infection
Types of hand surgery
The hand can be treated by several kinds of surgeries. It is based on the inherent cause. Procedures include:
- Skin grafts
Such procedures for the hand consist of attaching or replacing skin to the portion of the hand that suffers from missing skin. This procedure is mostly carried out for injuries or amputation of fingers. Skin grafts may be conducted by collecting a piece of skin that is healthy and derived from another part of the body, which is the donor site and attaching it to the area of injury.
- Skin flaps
Similar to a skin graft, the hand surgery procedure of skin flaps involves the use of skin from other regions of the body. But in such procedures, that skin is used, which has its own supply of blood. This is because a section of the skin used includes inbuilt blood vessels, muscles and fat. The surgeon uses flaps when the region of missing skin lacks a supply of blood. This happens when there is extensive damage to tissue and vessels or because of the location of the injury.
- Closed fixation
This procedure may be used when there is broken bone or bone fracture in parts of the hand like fingers. This kind of surgery does re-alignment of broken bone and makes it immobile whilst it heals. Internal fixtures may be used for immobilization like casts, splints, rods, and wires.
- Repair of tendons
Bones and muscles are joined by fibres called as tendons. Because of the tendon structure, its repair is a tough procedure. Injuries to tendons can occur due to sudden rupture, trauma, or infections.
There are 3 kinds of procedures for tendon repair.
Primary repair: This is a direct surgery conducted within 24 hours of sudden or acute injury
Delayed primary repair: Conducted within a few days after the injury, while there is an open wound.
Secondary repair: conducted typically 2 to 5 days from injury. This may involve tendon grafts or other complicated procedures.
- Nerve repairs
The nerves of the hand can be injured. This may result in a loss of feeling or loss of function in hand. Sometimes, nerve injury may heal on its own. But otherwise, it may need surgery. Surgery is typically conducted 3 to 6 weeks following injury. This time is best for nerve repairs linked to complex conditions.
For less complicated conditions, surgery may be conducted soon after injury. This improves the chances of full recovery. In case of severing or cut of nerves, it may be re-attached, or a nerve graft may be done. This comprises of the replacement of nerves with nerves from other regions of the body.
These procedures are conducted for treating compartment syndrome. Such painful conditions happen when there is swelling and high pressure in a compartment (small space) in the body. This may be caused by the injury. The pressure can impede the flow of blood to body tissue and damage function. In the hand, it causes muscle weakness and rising pain.
For this procedure, the surgeon will make an incision or cut in the arm or hand. This will lower pressure, permit swelling of muscle tissue, and restore the flow of blood. All tissues in the region which are already damaged can be removed during this stage. This helps in preventing any further damage or problems in hand function.
- Debridement or surgical drainage
Hand infections happen to be quite common. Treatment of hand infections includes surgery, anti-biotics, elevation, use of heat, and taking rest. In case there is an abscess or sore in the hand, pus can be removed through surgical drainage. In case the wound is severe, debridement may be used to clean contaminated and dead tissue from the wound. This promotes healing and prevents any chance of potential infection.
- Replacement of joints
Also referred to as Arthroplasty, this procedure is used to treat severe arthritis in the hand. It consists of the replacement of a joint that has been damaged by arthritis using an artificial joint. The latter may be made of one’s own tendon, silicone rubber, plastic, or metal.
In this procedure, a severed part of the hand may be re-attached. The aim is the restoration of maximum function. This procedure uses micro-surgery.
These are some of the surgical procedures that paediatric hand specialists perform.