Hand surgery encompasses a broad range of procedures to restore function and appearance of the hand following trauma, infections, congenital deformities, or rheumatic changes. Common types of hand surgery include skin grafts, tendon repairs, nerve repairs, joint replacements, and replantation of amputated fingers or hands using microsurgery. Risks of hand surgery depend on the procedure but can include infection, incomplete healing, loss of movement or feeling in the hand or fingers, and blood clots.

1. Overview of Hand
Surgery

2. What is hand surgery?
• Hand surgery is a broad term that incorporates a vast
array of different types of surgery on the hand. Plastic
surgeons who perform hand surgery attempt to restore
not only the function of the hand, but try to maximize
the cosmetic appearance of the hand, as well. Surgery on
the hand may be done for many reasons, including, but
not limited to, the following:
• Trauma to the hand
• Rheumatic changes to the structures in the hand
• Congenital (present at birth) deformities
• Infections

3. What are the different types of hand surgery?
Many different types of surgeries can be performed on the
hand, depending on the underlying cause of the problem. The
following is a brief overview of some of the types of surgery
that may be performed:
• Skin grafts. Skin grafts involve replacing or attaching skin to a
part of the hand that has missing skin. The most common
type of injury requiring a skin graft is fingertip amputations or
injuries. Skin grafts are performed by taking a piece of healthy
skin from another area of the body (called the donor site) and
attaching it to the needed area.
• Skin flaps. A skin flap is similar to a skin graft, in which a part
of the skin is taken from another area. However, with a skin
flap, the skin that is retrieved has its own blood supply.

4. • The section of skin used includes the underlying blood
vessels, fat, and muscles. Flaps may be used when an area
that is missing the skin does not have a good supply of blood
because of the location, damage to the vessels, or extensive
damage to the tissue.
• Closed reduction and fixation. This technique may be used
when there is a fracture in part of the hand, including the
fingers. This type of surgery attempts to realign the fractured
bone and then immobilize the area during the healing phase.
Immobilization can be done with internal fixtures, such as
with wires, rods, splints, and casts.
• Tendon repair. Tendons are the fibers that attach muscle to
bone. Repair of tendons remains a surgical challenge because
of the structure of the tendon.

5. • Tendon injuries can occur due to infection, trauma, or
spontaneous rupture. Repair of a tendon may be classified as
primary, delayed primary, or secondary. Primary repair of an
acute injury is usually completed within 24 hours of the injury.
Delayed primary repair is usually performed a few days after
the injury, but while there is still an opening in the skin from
the wound. Secondary repairs may occur two to five weeks or
longer after the injury. Primary repairs usually involve direct
surgical correction of the injury, while secondary repairs may
include tendon grafts (inserting tendons from other areas of
the body in place of the damaged tendon) or other more
complex procedures.
• Nerve repairs. There are three main nerves that innervate the
hand, including the ulnar nerve, the median nerve, and the
radial nerve.

6. • Damage to these nerves from injury may result in
decreased ability to move the hand and experience
feeling. Some nerve injuries may heal on their
own, while others require surgery. Overall, about
three to six weeks after the injury is the best time for
nerve repairs that are associated with other, more
complicated, injuries. Surgery to investigate a
damaged nerve that is not complicated by other
injuries is usually performed early after the
trauma, to increase the likelihood of a full recovery. If
severed, the nerve may be repaired by reattaching it
directly to the other end of the nerve, or by using a
nerve graft (inserting nerves from other areas of the
body in place of the damaged nerve) to repair the
damaged section.

7. • Fasciotomy. This procedure is performed to help treat
compartment syndromes. A compartment is a three-
dimensional anatomic space in the body that is surrounded by
fascia or bone and contains arteries, nerves, and veins. A
compartment syndrome is a condition that arises when there
is an increase in intracompartmental tissue pressure within a
space in the body, usually caused by trauma, which can
interfere with the circulation to the body tissues and destroy
function. In the hand, a compartment syndrome may lead to
severe and increasing pain, muscle
weakness, and, eventually, a change in color of the fingers or
nailbeds.
Fasciotomy is the treatment for the early stage of
compartment syndromes. Surgical incisions are placed in the
hand or arm to allow a release of the pressures that are
increasing inside the body. Any tissue inside the body that is
already damaged may be removed at this time

8. • A fasciotomy will help prevent a further decrease in function
and damage of the affected extremity.
• Surgical drainage and/or debridement. Our hands are
constantly at risk for injury and infection. Infections of the
hand are a common reason people seek treatment. The
treatment for infections to the hand may include rest, use of
heat, elevation, antibiotics, and surgery. Surgical drainage may
be used if there is an abscess in the hand to help remove the
collection of pus. Debridement, or cleansing of a wound to
prevent further infection and to help promote healing, may
be used if the infection or wound is severe.
• Joint replacement. This type of surgery, also called
arthroplasty, may be used in people with severe arthritis of
the hand.

9. • This involves replacing a joint that has been destroyed by the
disease process with an artificial joint. This artificial joint may
be made out of metal, plastic, silicone rubber, or the patient's
own body tissue (such as a tendon).
• Replantation. This type of surgery replaces fingers or hands
that have inadvertently been amputated, usually by some
type of trauma. Replantation uses microsurgery, which is an
intricate and precise surgery that is performed under
magnification. Some severe injuries may require more than
one surgery for optimal recovery.
• What are the risks of hand surgery?
• Most surgery carries the risks of anesthesia and bleeding.
Additional risks associated with surgery depend greatly
on the type of surgery being performed and may include,
but are not limited to, the following:

10. • Infection
• Incomplete healing
• Loss of feeling or movement of the hand or fingers
• Blood clots may form
POSTED BY ATTORNEY RENE G. GARCIA:
For more information:- Some of our clients have suffered this
kind of injuries due to a serious accident. The Garcia Law
Firm, P.C. was able to successfully handle these types of cases.
For a free consultation please call us at 1-866- SCAFFOLD or
212-725-1313.
http://www.hopkinsmedicine.org/healthlibrary/conditions/plastic_surgery/overview_of_hand_surgery_85,P01130/