Your hands are an integral part of your daily life. You use them to work, cook, socialize, express your emotions, exercise, and much, much more! This means that protecting your hands is of the utmost importance but it also means they are susceptible to wear and tear.
In fact, each year nearly 124,000 hand injuries occur in workplaces across America. On top of this, a huge proportion of the US population suffers from degenerative hand conditions.
Thankfully, hand surgeries and other treatments are available to combat the effects of some of these conditions and injuries. Thanks to expert hand surgeons, it is possible to recover the use of your hands even after a traumatic injury.
So what does hand surgery involve? If you want to know more about the various different types of hand surgeries available in the United States, you’re in the right place! Read on to find out more.
What Is Hand Surgery?
There are over 2,000 practicing surgeons in the United States who specialize in hand surgery. This involves correcting a whole range of hand injuries and conditions.
Some injuries, such as carpal tunnel syndrome, develop over an extended period of time. Others may be the result of sudden trauma to the hand. This is why the specialisms of different surgeons can vary a lot.
72.1% of hand surgery associates in the US identify as orthopedic surgeons, while the rest work as plastic surgeons or general surgeons. Collectively they perform surgery to deal with a whole range of issues including:
- Sudden, traumatic injuries, such as breaks and burns
- Hand infections
- Rheumatic conditions that affect the structure of the hand, such as osteoarthritis or rheumatoid arthritis
- Degenerative conditions that affect the structures of the hand
- Defects to the hand’s structure that were present at birth
This means that there are a lot of different types of hand surgeries that you might experience during your life. These procedures are quite different from one another and may require different recovery times.
To understand more, let’s take a closer look at some of the different types of hand surgery.
You may be familiar with the concepts of skin grafts already. This involves taking a section of skin and tissue from one area of the body and attaching it elsewhere. This occurs when the skin on your hands (or elsewhere) has become damaged or is missing completely.
Skin grafts will often be used if a patient has lost an area of skin on their hand because they have:
- Suffered a burns injury
- Suffered a fracture that broke the skin of the hand
- Had a section of cancerous skin removed
- Had a section of their hand amputated
Skin grafts are often performed by surgeons who have experience in plastic surgery. This expertise allows them to graft the skin to the hand in a way that will produce minimal scarring.
In some situations, a skin graft will not work effectively to replace a missing area of skin on the hand. This happens if the area below the missing skin has also been damaged.
When this happens, tissue and blood vessels below the skin will no longer be able to provide it with the blood supply it needs to thrive. This means that a graft would not be successful.
Instead, a surgeon will use a flap of skin that already has its own blood supply. This means that it will thrive in spite of the damage to the area below the skin.
There are many different types of flaps that a hand surgeon may use, and it depends on the location and extent of the injury. Common flaps are called “V to Y” flaps or local advancement flaps, where tissue near by, is moved to cover defects, as opposed to other common flaps of fingers, known as “cross finger flaps” or “thenar flaps.” These are more involved, and relies on other areas in the region to donate tissue to help cover larger defects in the injured body part.
Broken Bones or Fractures: Closed or Open Reduction and Fixation Surgery
What is the difference between a fracture and a break in the bone? There are certainly just two ways of looking at a bone that is injured to the point that there is some disruption of its cortex (outer layer).
Closed reduction or open reduction and fixation surgery (CRIF or ORIF) is just a fancy name for the surgery needed after a bone fracture. If a surgeon determines you need surgery, he would want to optimally realign the bones and then hold them in place to heal.
Sometimes you can do this without making an incision (closed) and sometimes it needs an incision to get down to the bone (open). The way the doctor chooses to hold the bones in place (fixate) can vary as well, from wires or pins, to screws, to plates and screws, to devices that act like scaffolds outside the hand or wrist (external fixators).
During reduction and fixation surgery, hand surgeons realign the broken bone to its original position. They may also use rods or pins alongside the bones to keep them in place.
The good news is that not all broken bones require surgery. In fact, the majority of them can be repaired with the help of a splint or plaster cast. However, some major fractures require realigning before they can start to heal. That is called reducing a fracture and then the patient is usually casted or splinted to ensure it stays in that position.
Usually, another x-ray is needed once the process is done to ensure it is in proper alignment. If after reduction and casting / splinting, the fracture does not hold, it is considered unstable and needs fixation in order to heal properly.
After surgery, you will also usually have to wear a splint or cast for around six weeks while the bones reset. If you have any rods or pins in your arms, a surgeon will remove these at a later date.
Tendon Repair Surgery
The tendons in your hands (and the rest of your body) play a vital role in attaching your muscles to your bones. These are fibrous stands, which makes repairing them very difficult.
There are a number of ways that you can damage the tendons in your hands and all of these will require surgery. Infections, traumatic injuries, or sudden ruptures will all need repairing in surgery.
Tendon injuries need to be repaired as soon as possible for the best results. Some surgeons perform a technique that repairs the tendons while they are wide awake (WALANT).
The WALANT is a pneumonic that stands for Wide Awake Local Anesthesia No Tourniquet. The patient has minimal pain or discomfort, but the advantage is the surgeon can test out the surgical repair immediately, and make any adjustments, thus ensuring a better outcome.
Flexor and extensor tendons are the tendons injured in the hand. Hand surgeons divide the location of the injuries on the hand into Zones because injuring tendons in different locations on the hand or fingers, can yield many different outcomes.
For instance, Zone II on the palmar side of the hand (the area between the distal palm crease and the first crease on the finger) is the area known as “no man’s land” because of the associated less-than-optimal results in this area due to the pulleys, and scarring.
There are three different types of hand tendon surgery and these depend on the type of damage that your tendons have suffered.
Primary repair surgery is usually performed after a sudden injury to the tendons in your hand. This takes place in the first 24 hours after you suffer an injury.
Delayed primary repair surgery takes place in the days following a tendon injury. Often the surgeon will use the skin opening caused by the trauma in order to access the tendon.
Secondary repair surgeries take place between two and five weeks after an injury. These are performed on more complex injuries that require more extensive repairs. For example, secondary repairs may involve grafting tendons from other areas of the body.
Post-op care and therapy are probably equally if not more important for a patient than the actual surgery, in order to achieve the best possible outcome. Patients should be prepared to invest a significant amount of time after surgery for therapy, for several months.
Nerve Repair Surgery
Your hand contains a lot of nerve endings. These allow you to control the movement in your hand and fingers and are responsible for the feeling that you have in it. However, suffering a hand injury can result in damage to the nerves in your hand. Most of the time they occur with a flexor tendon injury of the finger.
Nerve damage can result in tingling or loss of feeling in your hand. So if you’ve suffered a hand injury recently, this is a sign you may need surgery. Keep in mind, not all nerves perform the same function. Some nerves solely provide sensation to a specific area, these are called sensory nerves. Other nerves innervate muscles, known as motor nerves. Others perform both functions, innervating specific muscles while providing sensation to others and are known as mixed nerves. A good example of this is the median nerve of the hand and upper extremity. It is a mixed nerve as it innervates muscles of the hand, and also provides sensation to the tips of the finger. As these nerves branch off into the fingers, their function turns to purely sensory.
Like tendons, the best outcomes occur when nerves are repaired as close to the time of injury. Repair of nerves does not ensure that feeling will return. The surgeon will reattach the nerves in the best alignment possible, but the nerve still has to regenerate on its own, which can take several months.
Surgeons will sometimes use neural tubes of various types to ensure that the ends grow across, or if there is a gap the tube acts as a conduit, to try to meet the other side.
A nerve repair may involve reattaching one end of the nerve to the other if it has been cut or severed. In some cases, your surgeon may graft a nerve ending from elsewhere in your body. This happens if the existing nerve is damaged beyond repair.
A fasciotomy is the name of the surgery used to relieve compartment syndrome. This condition can be caused by bleeding or swelling within the muscles of your hands and wrist. This causes pressure to build up in the affected area.
As this pressure builds is can cut off the blood and oxygen supply to areas of your hand. This is often extremely painful.
A fasciotomy involves making an incision into the affected area to relieve the pressure on your hand and wrist. This allows blood and oxygen to flow as normal through your hand.
If any of your tissue has been affected by compartment syndrome, a doctor will remove this during the procedure as well. This stops it from causing further damage to your hand and wrist.
Surgical Drainage or Debridement
Hand infections are fairly common injuries that can be caused by a huge range of things. Any cuts, grazes, or openings in your skin can leave you exposed to an infection.
However, these can escalate very quickly if you don’t treat them properly. Minor infections are usually treated using antibiotics, heat, or elevations.
As an infection develops it can turn into a sore or an abscess. When this happens, it may need to be surgically drained. This involves removing the puss from the affected area to clean it.
During surgery for more severe infections, the surgeon may also remove any damaged or dead tissue. This stops the infection from spreading or returning so that you recover as quickly as possible.
Joint Replacement Surgery
Hand surgery for arthritis is a very common type of surgery. Arthritis generally affects those who are over the age of 40 although it can affect teenagers!
It is currently one of the most common hand conditions in the United States. In fact, more than 54 million Americans are currently living with arthritis.
This affects the cartilage in your joints, which is the protective layer between your bones. Over time your cartilage may get worn down or weaken and crumble.
As this happens, there is less protection between your bones which means they rub together when you move. This can be extremely painful and often occurs in a specific area of your hand.
It is not possible to replace the cartilage between your bones. However, in cases of severe arthritis, it is possible to replace the joint entirely. Most artificial joints are made using either metal, plastic, or silicone rubber.
During surgery, the surgeon removes your original joint and replaces it with a new artificial one. This repairs any lack of mobility caused by your arthritis and will also stop you from feeling pain in that joint. Although it is an extensive surgery, joint replacement is a very successful way to deal with arthritis!
Replantation surgery is one of the most complicated types of hand surgery around. This involves reattaching part of the body that has become severed from the body, such as a finger. Often this takes place following a serious traumatic injury and is considered emergency surgery.
The main goal of replantation surgery is not just to reattach the body part but to give it as much function as possible. This involves an extremely intricate procedure in which the surgeon has to reattach all the blood vessels and nerve endings.
Because of the amount of detail involved, surgeons have to use magnification and minute surgical tools. This is also known as microsurgery.
To maximize the chances of success, replantation surgery should take place as soon as possible after an injury. The longer that a body part remains severed from the body, the less likely replantation is to work.
In some cases, replantation may require more than one surgery in order to restore function.
Risks of Hand Surgery
All medical surgery comes with an element of risk, which is why it is important to discuss your options with your doctor thoroughly.
Anesthesia and bleeding are complications that can arise with any type of surgery. Before your surgery, your doctor will ask you a range of questions about your medical history. It is important to answer these as thoroughly as you possibly can to avoid complications in surgery.
Other complications involved with hand surgery include:
- Infections or incomplete healing of wounds
- Loss of feeling and/or movement in your hand or fingers
- Blood clots forming in the hand
Following your post-operative care as closely as possible will minimize the risk of complications. This is why it is important to take all of your doctor’s advice following surgery. Taking the time to rest properly will make for a much faster recovery time.
If you do notice any issues or things that concern you following hand surgery, do not hesitate to ask your doctor about these. They may not indicate a problem but if they do, catching that as soon as possible is key!
Get Help With Your Hand Surgeries Today!
As you can see, when it comes to hand surgeries doctors can treat a whole host of different conditions.
The most important thing you can do is to protect your hands and look out for signs of injuries as soon as possible. The sooner you get help for your hand injuries the better!
If you have a hand injury or condition that you are concerned about, get in touch today to speak to one of our team. We’re here to help!