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Hand Surgery

WHAT IS HAND SURGERY?
If your hand is impaired in any way, surgery may improve your condition. This type of very specialized surgery can treat diseases that cause pain and impair the strength, function, and flexibility of your wrist and fingers.
The human hand is one of the most versatile tools in nature. It not only fulfills countless physical functions but is also a communication and sensory tool. Illness, injury, or a congenital deformity (one present at birth) can diminish the ability to manipulate our hands to grasp, pinch, wave, touch, shake hands, or perform countless other functions.
Some of the more common hand surgery procedures are used to treat victims of trauma and carpal tunnel syndrome.
In general, hand surgery is a good option for you if:
• You do not have additional medical conditions or other illnesses that may impair healing
• You are a non-smoker
• You have a positive outlook and realistic goals for your hand surgery
• You are committed to following your plastic surgeon’s prescribed course of treatment
• It is necessary to treat wounds and to help painful conditions.


CONSULTATION & PREPARATION FOR SURGERY
During your consultation, be prepared to discuss:
• Your surgical goals
• Medical conditions, drug allergies, and medical treatments
• Current medications, vitamins, herbal supplements, alcohol, tobacco, and drug use
• Previous surgeries
Your surgeon will also:
• Evaluate your general health status and any pre-existing health conditions or risk factors
• Take photographs
• Discuss your hand surgery options
• Recommend a course of treatment
• Discuss likely outcomes of hand surgery and any risks or potential complications.

Prior to surgery, you may be asked to:
• Get lab testing or a medical evaluation
• Take certain medications or adjust your current medications
• Stop smoking
• Avoid taking aspirin, anti-inflammatory drugs, and herbal supplements, as they can increase bleeding.
Your plastic surgeon will also discuss where your procedure will be performed. Depending on the type of surgery you will undergo may be performed in your plastic surgeon’s accredited office-based surgical facility, a licensed ambulatory surgical center, or a hospital.


THE PROCEDURE
Step 1 – Anesthesia
Medications are administered for your comfort during the surgical procedures. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.
Step 2 – The incision
Treating trauma
The most common traumatic hand or finger injury requiring hand surgery is tendon repair. When a tendon is cut, it will retract from the original wound site. Tendon repair retrieves the retracted tendon and reconnects it using surgical techniques to restore function and movement.
Carpal tunnel syndrome relief
Pressure on the median nerve in the carpal tunnel must be relieved to repair this condition. An incision is made from the middle of the palm to the wrist, allowing access to the constricted tissue and causing pressure on the nerve. An alternate procedure is referred to as an endoscopic carpal tunnel release, with smaller incisions (see blue dotted lines) and a surgical microscope or endoscope, a small flexible tube containing a light and lens, to release pressure.
Step 3 – Closing the incisions
Depending on your condition and type of treatment, you may have incisions that need to be closed with removable sutures, or your plastic surgeon may use non-removable sutures.
Step 4 – See the results
The results of hand surgery will appear gradually as swelling subsides. Your final outcome may not be realized for several months.

RISKS & SAFETY
The decision to have hand surgery is extremely personal, and you’ll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable. You will be asked to sign consent forms to ensure that you fully understand the procedure and any risks and potential complications.
The risks include:
• Allergies to tape, suture materials and glues, blood products, topical preparations or injected agents
• Anesthesia risks
• Bleeding
• Blood clots
• Change in skin sensation
• Damage to deeper structures such as nerves, blood vessels, muscles, and lungs
• Deep vein thrombosis, cardiac and pulmonary complications
• Fluid accumulation
• Infection
• Pain, which may persist
• Poor healing of incisions
• Possibility of revision surgery
• Skin contour irregularities
• Skin discoloration/swelling
• Unexpected hand swelling
• Unfavorable scarring
These risks and others will be fully discussed prior to your consent. It’s important that you address all your questions directly with your plastic surgeon. Additional risks associated with these specific surgeries include:
Carpal tunnel
• Non-improvement
• Recurrence of carpal tunnel syndrome
Extensor tendon
• Additional incisions may be necessary because cut tendons may retract
• Failure of tendon repair
• Inability to restore function
• Tendon scarring
Flexor tendon
• Additional incisions may be necessary because cut tendons may retract
• Inability to restore function
• Tendon scarring
Trigger finger
• Non-improvement
• Tendon scarring

RECOVERY AFTER SURGERY
After surgery, bandages or dressings may be applied to keep the surgical site clean, and splints may be used when needed.
You will be given specific instructions, including how to care for your hand(s) following surgery, medications to apply or take orally to aid healing and reduce the risk of infection, and when to follow up with your plastic surgeon.
Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period.
• Where will I be taken after my surgery is complete?
• What medication will I be given or prescribed after surgery?
• Will I have dressings/bandages after surgery?
• When will they be removed?
• Are stitches removed? When?
• When can I resume normal activity and exercise?
• When do I return for follow-up care?
Follow all postoperative instructions, including cleansing, taking prescribed medications, and hand therapy exercises. Therapy is critical to restoring strength, flexibility, and movement. If you attempt to return to normal function too soon, the risk of re-injury is possible. Continue your hand therapy regimen and attend follow-up visits with your plastic surgeon as scheduled. This is essential to a successful outcome.

RESULTS
As swelling subsides, the results of hand surgery will appear. Your final outcome may not be realized for several months. The end result of your hand surgery is directly related to following your therapist’s and plastic surgeon’s instructions.
The final outcome of your hand surgery will develop over time. Your outcome cannot be fully predicted.
Although good results are expected from your procedure, there is no guarantee. In some situations, achieving optimal results with a single surgical procedure may not be possible, and another surgery may be necessary.

COST
Prices can vary for hand surgery. A surgeon’s cost may be based on his or her experience, the type of procedure used, and the geographic location of the office.
Cost may include:
• Anesthesia fees
• Hospital or surgical facility costs
• Medical tests
• Post-surgery rehabilitation
• Prescriptions for medication
• Surgeon’s fee
Your health insurance plan will likely cover hand surgery and related complications. Pre-certification is generally required for reimbursement or coverage. Be sure to consult with your insurance company before any surgery.
NOTE: Your satisfaction involves more than a fee:
When choosing a plastic surgeon for hand surgery, remember that the surgeon’s experience and your comfort with him or her are just as important as the final cost of the surgery.

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