Hand Trauma Reconstructive Surgery

Traumatic injuries can cause complex injuries in the hand, injuring multiple tissues including bones, tendons, blood vessels, nerves, and/or skin. Hand surgeons are skilled at repairing these complex injuries, with the goal of improving hand movement and flexibility over time.

The treatment of mutilating injuries is complex and is based on a clear understanding of principles of wound management, fracture fixation, and soft-tissue reconstruction.

Debridement, bony stabilization, revascularization, and soft-tissue cover should be achieved in the primary surgery. Nerve and tendon reconstruction can be performed as delayed procedures. 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.

After the surgery, surgeons work closely with hand therapists to make sure the hand can work as well as possible after the injury.

Reconstructive hand surgery may be necessary to address deformities that occur because of:

  • Amputation
  • Burns
  • Congenital anomaly
  • Injury/accident/falls
  • Mangled hand and upper extremity trauma

Some of the surgical techniques used in reconstructive hand surgery include:

Microsurgery

Sometimes, hand injuries can also injure the tiny blood vessels in the hand and wrist. In these cases, surgeons use a microscope to reconstruct these injured blood vessels. Surgeons use microsurgical skills to perform blood vessel reconstruction. The most advanced surgical microvascular technique demands the delicate and precise use of a microscope to repair nerves and arteries of the hand and fingers. This surgical approach requires a specialist to work on tiny blood vessels, ranging from three to five millimeters in diameter. The surgeons also use specialized instruments such as very small needles that can produce very fine stitches. Microvascular surgery allows to restore blood supply, repair nerves, and prevent the total loss of the hand or finger.

Tissue Transfer

Hand reconstruction may require the transfer of tissue from one’s own body to close large wounds. Microvascular surgery may be needed to reattach blood vessels from the flaps to the hand to provide skin coverage and promote healing. These are demanding surgical procedures that require a team of specialists.

Replantation Surgery

Replantation refers to the surgical reattachment of a finger, hand, or arm that has been completely cut from a person’s body. Replantation surgery is the ultimate form of reconstruction following an amputation. It provides like for like composite tissue and the best chance of functional recovery. Properly preserved amputated fingers and thumbs can be reattached up to 24 hours after the amputation. However, there is a better chance of success if the surgery is done within 6-12 hours. Surgery involves fixing the bone, repairing cut tendons, and microsurgical repair of cut blood vessels and nerves. This can take between 3-6 hours for each amputated finger, depending on the severity of the injury. Ultimately, the goal of replantation surgery is to give the patient back as much use of the injured area as possible.

Skin grafts

Skin grafts for the hand involve replacing or attaching skin to a part of the hand that has missing skin. Skin grafts are done by taking a piece of healthy skin from another area of the body, called the donor site, and attaching it to the injured area.

Skin flaps

Like a skin graft, skin flaps for the hand involve taking skin from another part of the body. But this procedure uses skin that has its own blood supply. That’s because the section of skin that is used includes the underlying blood vessels, fat, and muscles. Flaps may be used when an area that is missing skin does not have a good blood supply. This may be because of the location, damage to the vessels, or extensive tissue damage.