Advanced Hand Surgery

Brachial Plexus

The Brachial Plexus is a network of nerves that conveys movement and sensory signals from the upper spinal cord in the neck down into the arms and hands.

Trauma to the neck or shoulder can injure the brachial plexus, causing pain, numbness, weakness, or paralysis in the arms or hands.

Some brachial plexus injuries heal on their own with normal or near-normal function. For more severe injuries, brachial plexus surgery may be the best chance to relieve pain and restore sensation and mobility.

Arthroscopy:

This surgery is also known as “keyhole surgery”. In this surgery a camera also called an arthroscope is used to examine and treat tissues inside or around your wrist. Arthroscopy helps the hand surgeon to know the issue and treat the wrist without making huge incision to the skin and tissues. This also help in reduced pain and faster recovery. Wrist arthroscopy helps to diagnose certain ligamentous injuries of the wrist.

Microsurgery:

When a microscope is used to do a surgery, it is called Microsurgery.  As the name suggests, using a microscope the surgery can be done under greater magnification (up to 40X). This helps in the treatment of fine vital structures called blood vessels and nerves. Extremely fine sutures that are the size of a hair strand are used to perform microsurgery.  This surgery needs years of practice. Microsurgery is generally done in the emergency situation to reattach amputated body parts usually fingers and in the elective situation to resurface soft tissue defects resulting from trauma or resection of tumours.

Need for brachial plexus surgery

• People with neck or shoulder trauma
• People with continuing, debilitating pain or loss of function in the arm after a trauma or because of nerve damage during surgery.
• People with scarred nerves that form tumors called neuromas.
• People with nerve tumors of the brachial plexus that were not caused by trauma, such as schwannomas and neurofibromas.

Types of Brachial Plexus Surgery – The goal of brachial plexus surgery is to relieve the pain and restore sensation and motor function to the shoulder, arm, and hand.

• Brachial Plexus Nerve Repair
• Brachial Plexus Decompression and Neurolysis
• Nerve Grafting Surgery for Brachial Plexus Injuries
• Brachial Plexus Nerve Transfer Surgery
• Tendon Transfer Surgery for Brachial Plexus Injuries
• Functional Muscle Transplant for Brachial Plexus Injuries

Recovery After Brachial Plexus Surgery

Recovery after brachial plexus surgery includes healing of the tissues that were operated on and recovery of lost function. While healing of the tissues is relatively quick, function recovery may take months depending on the procedure you had and the extent of the injury.

After nerve repair, grafting, and transfer, a period of nerve regeneration is required before movement and sensation improved. This can take months to years, depending on the type of surgery performed.

Joint Replacement Surgery:

This surgery is also known as implant arthroplasty. In joint replacement surgery a diseased joint is replaced by an artificial joint. This joint is typically made of metal (titanium) although ceramic based implants are also available. Earlier fusion of the joint surgery was commonly performed for treating diseased joints mostly in the hand and wrist. Joint fusion also known as arthrodesis rectifies the deformity and pain however it results in loss of motion and can be very disabling. Joint replacement allows motion at the diseased joint, thus improving the quality of life.

Limb Replantation

Limb replantation is a complex microsurgical procedure that allows patients to have severed limbs reattached or “replanted” to their bodies. Most patients need limb replantation within hours of experiencing traumatic injuries.

Depending on the type of injury, surgical specialists can replant some severed limbs. Replantation is more common for upper arms, hands, and fingers.

Congenital Hand Problems

It is a group of conditions where the hands of children are different in form in terms of shape, number, or length. Examples would include syndactyly and thumb duplication. Patients usually have an X-ray taken of their hands and corrective procedures planned after a detailed consultation with the child’s parents to understand their expectations.

Post-traumatic Deformity

 This is caused by inadequate treatment of acute trauma is another area of surgery. These patients present with a deviation of their fingers or scissoring on making a fist and are mostly to have malunion of a previous fracture. After appropriate imaging, corrective osteotomies are performed to improve the alignment and function of the fingers.