Hand and Reconstructive Microsurgery

Hand injuries at times injure the tiny blood vessels in the hand and wrist. In these cases, surgeons use a microscope to repair/ reconstruct these injured blood vessels. Hand surgery is a broad term that covers many different types of procedures. Reconstructive surgery of the hand may be done for many reasons, including:

• Hand injuries
• Rheumatic diseases, such as osteoarthritis and rheumatoid arthritis, that change and damage the structures in the hand
• Degenerative changes to the structures in the hand
• Problems or defects of the hand that are present at birth, or congenital
• Infections of the hand

Traumatic injuries can cause complex damage to the hand, causing trauma in the bones, tendons, blood vessels, nerves, and/or skin. Some injuries can be repaired in a single surgery, but other injuries will need a staged approach or multiple surgeries. Often, multiple parts of the hand need to be repaired, requiring individualized care both during and after surgery.

Reconstructive hand surgery is primarily performed to rebalance the hand for useful function. It can also often improve the appearance of the hand cosmetically, and in doing so, improve the patient’s self-image. The real reason for reconstructive surgery is to rebalance the fingers and hand in order that they work in normal positions that allow the hand to be used satisfactorily. Hand surgeons have developed specialized techniques for the restoration of hand conditions that maximize the effectiveness of reconstructive surgery.

1. 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.

2. Limb Replantation

Limb replantation is a complex microsurgical procedure that allows patients to have severed limbs reattached or “replanted” back 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.

3. Post-traumatic Deformity

This is caused by inadequate treatment of acute trauma. 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.

4. Nerve & Blood Vessel Reconstruction

Traumatic injuries to the arm, hands, and fingers, can tear the delicate nerves and blood vessels inside the body. When this happens, surgeons use a special procedure to sew (or suture) torn ends of nerves and blood vessels back together.

During nerve and blood vessel reconstruction, hand surgeons rely on magnification technology to see close-up images to repair these delicate parts of the body (microsurgery). Surgeons use a microscope to suture blood vessels.

Surgeons also perform nerve and blood vessel reconstruction during finger replantation procedures, relying on microsurgery. Blood vessel reconstruction procedures tend to be very successful, restoring blood flow that keeps the extremities alive.

While nerve reconstruction won’t help the hand work the way it did before the injury, nerve reconstruction does bring back substantial function to the nerves.

5. TendonRepair

Tendons are the fibers that join muscle to bone. Tendon repair in the hand is a difficult surgery because of the structure of the tendon and the narrow tunnels through which tendons pass. Rarely tendon injuries may occur due to infection.

6. Nerve Repair

An injury can damage the nerves in the hand. This can cause a loss of muscle function and a loss of feeling in the hand. Some nerve injuries may heal on their own. Others may require surgery.

If the nerve is cut or severed, it may be fixed by reattaching it to the other end of the nerve. If the cut ends cannot be bought together, a nerve graft may be done. This involves replacing the damaged nerve with nerves taken from other areas of the body.

7. Joint Replacement

This type of surgery, also called arthroplasty, is used in cases of severe hand arthritis. It involves replacing a joint that has been destroyed by arthritis with an artificial joint. This artificial joint may be made of metal, plastic, silicone rubber, or the own body tissue, such as a tendon.

8. Fasciotomy

This procedure is done to help treat compartment syndrome. This painful condition occurs when there is swelling and increased pressure in a small space, or compartment, in the body. Often this is caused by an injury. This pressure can interfere with blood flow to the body tissues and destroy function. Compartment syndrome may cause severe and increasing pain and muscle weakness.

For a fasciotomy, the doctor will make a cut or incision in the hand or arm. This decreases the pressure, lets the muscle tissue swell, and restores blood flow. Any tissue inside the area that is already damaged may be removed at this time. This procedure helps prevent any further damage and decrease in function of the affected hand.

9. Surgical drainage or Debridement

Hand infections are very common. Treatment for hand infections may include rest, using heat, elevation, antibiotics, and surgery. If there is a sore or abscess in the hand, surgical drainage may help remove any pus. If the infection or wound is severe, debridement may be used to clean dead and contaminated tissue from the wound. This prevents further infection and helps promote healing.

10. Brachial Plexus Injuries

The brachial plexus is a network of intertwined nerves that control movement and sensation in the arm and hand. The plexus is located on either side of the neck. A traumatic brachial plexus injury involves sudden nerve damage and may cause weakness, loss of feeling, or loss of movement in the shoulder, arm, or hand.

Mild brachial plexus injuries may heal without treatment. More severe injuries may require surgery to regain function of the arm or hand

11. Carpal Tunnel Syndrome

In the center of the wrist, there is a space called the carpal tunnel where a major nerve (the median nerve) and nine tendons pass from the forearm into the hand. A very strong ligament forms a roof over the tunnel. When there is swelling in the carpal tunnel, pressure is put on the median nerve, which supplies most of the fingers and thumb with feeling and movement. When the pressure becomes great enough to compress the nerve, resulting in Carpal Tunnel Syndrome.

When symptoms are severe or do not improve with non-surgical treatments, surgery may be elected to enlarge the carpal tunnel by cutting (releasing) the ligament to allow more room for the median nerve.

12. Cubital Tunnel Syndrome

This happens when the ulnar nerve, which passes through the cubital tunnel (a tunnel of muscle, ligament, and bone) on the inside of the elbow, becomes inflamed, swollen, and irritated. Cubital tunnel syndrome causes pain that feels a lot like the pain you feel when you hit the “funny bone” in the elbow. The “funny bone” in the elbow is the ulnar nerve, a nerve that crosses the elbow. The ulnar nerve starts in the side of the neck and ends in the fingers.

When symptoms are severe or do not improve with non-surgical treatments, surgery may be elected.