Hand surgery has been increasingly seen as a specialty in recent years. As a result, the Ministry of Health started to give specialty diplomas to some plastic surgeons by evaluating their clinical and scientific studies, and hand surgery was defined as a subspecialty. Hand surgery is mainly concerned with the treatment of hand injuries, degenerative hand diseases and congenital disorders. The aim of hand surgery is to improve both function and appearance. This article is designed to tell you what common hand problems are, what plastic surgeons do to correct these problems, and the results. It is not possible to answer all your questions, because each problem is unique and dependent on individual differences. If there is anything you do not understand about the procedure, be sure to ask your doctor.
If you’re considering surgery for a problem with your hands, it’s a good starting point to talk to a plastic surgeon. Your surgeon will evaluate you, explain the treatment methods, and decide whether surgery is necessary. If surgery is decided, the surgical procedure, where the surgery will be performed (in the practice, clinic or hospital), type of anesthesia and surgical techniques to be used, possible risks and undesirable results, recovery and rehabilitation period, and possible results in function and appearance are discussed.
The most common procedures in hand surgery; It includes repairing damage to tendons, nerves, vessels and joints, broken bones and repairing burns and skin injuries. Modern techniques have greatly increased the surgeon’s ability to restore function and appearance, even in severe injuries. One of the most important points to remember is to start the treatment of hand injuries as soon as possible.
In many cases, significant sensation and function can be restored to injured hands as a result of surgery. But recovery can take months and often requires rehabilitation.
Carpal Tunnel Syndrome
The carpal tunnel is a tunnel where the tendons of the wrist and one of the important nerves in the sense and function of the hand pass. The pressure inside the tunnel can increase after various diseases, injuries, fluid collection during pregnancy, overuse or repetitive movements. This increased pressure on the nerve inside the tunnel causes an electrifying sensation, often accompanied by numbness, pain, and impaired hand function. Although the problem of hand splints and anti-inflammatory drugs can be resolved in some cases, surgery will often be required due to recurrent traumas. Surgical intervention is performed by open or closed (endoscopic) method.
Rheumatoid arthritis is an inflammation of the joints, a disabling disease that can affect the appearance and function of the hands and other parts of the body. It often deforms the knuckles and forces the fingers to stay in a bent position, impeding movement.
Disability caused by rheumatoid arthritis can often be treated without the use of surgery, for example; Physical therapy can be done using special devices or to strengthen weakened areas. But for some patients, surgery is the best solution. Talk to your surgeon and your rheumatologist and decide whether or not to have surgery.
In Dupuytren’s contracture, which is a disease of the hand function of the skin and subcutaneous tissue of the palm of the hands, clinically nodular and linearly thickened, scar-like tissues first move towards the palm and then towards the fingers, pulling the fingers towards the palm and significantly hindering hand functions. This disease usually develops in middle age and although it has no known cause, it may be familial.
In the early period of surgical treatment, the thickened tissue bands should be completely removed and the beams should be freed. The surgery must be done very carefully because the nerves of the hand and fingers are often firmly attached to this abnormal tissue. In some cases, the wound can be closed with a skin patch from another part of the body, as the thickened and folded skin is surgically removed.
Congenital anomalies of the hand are a condition that occurs during development in the mother’s womb and are observed at birth. These anomalies become more evident with the development of the hand and cause significant problems in the use of the hand. With the developing surgical techniques, most of the disorders are corrected at a very early age or at the age of 2 or 3 years, just before the child learns hand functions.
The most common congenital hand anomaly is syndactyly (conjoined). Here two or more fingers are joined. Surgical treatment should be done before 2 years of age. In the treatment, the tissues connecting the fingers are cut, and skin grafts taken from another part of the body are used to cover all surfaces of both fingers. The procedure becomes more complicated if the bones are also joined. Although surgery also provides full movement and a near-normal appearance, the color of the grafted skin may be slightly different from the other skin.
Other common congenital anomalies include extra fingers, duplicated thumb, short, missing or deformed fingers, immobile tendons, and abnormal nerve or vessel structures. In most patients, these defects are corrected surgically.
Recovery and rehabilitation
Since the hand is a very sensitive organ of the body, there may be mild to severe pain after surgery. Your surgeon can help you relax with injections or medication. How long your hand will be immobilized and how quickly it will regain normal activities depends on the type and extent of surgery and how quickly you can recover.
Physical therapy by an experienced hand therapist may be necessary for your hand to heal faster and to use it better. Your therapy may include hand exercises, massage therapy, electrical nerve stimulation, splinting, stretching and special wraps.