When Should I see a Hand Surgeon?
Dr. Roth is committed to individualized, compassionate care. Before beginning any treatment, you will have a complete consultation. He will examine your hand, evaluate your health history, discuss your treatment goals, and determine the best option for your needs. Dr. Roth wants you to be an active participant in your treatment. He will keep you fully informed, and if there are multiple procedural options, he encourages you to participate in creating your treatment plan.
We proudly offer the latest in surgical techniques, including skin grafting and flap surgery. While Dr. Roth is fully equipped to treat cosmetic and external concerns, he also specializes in the treatment of nerve, bone, and tendon injuries. Thanks to this broad range of expertise, he can address an array of hand issues, including traumatic injuries, congenital deformities, arthritis, and more.
What are the different types of hand surgery?
Many different types of surgeries can be performed on the hand. It depends on the underlying cause of the problem. These procedures include:
Skin grafts
Skin grafts involve replacing or attaching skin to a part of the hand that has missing skin. This surgery is most often done for fingertip amputations or injuries. 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, a skin flap involves 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.
Closed reduction and fixation
This may be used when there is a bone fracture, or broken bone, in part of the hand, including the fingers. This type of surgery realigns the broken bone and then holds it in place, or immobilizes it, while it heals. Immobilization can be done with internal fixtures, such as with wires, rods, splints, and casts.
Tendon repair
Tendons are the fibers that join muscle to bone. Tendon repair is a difficult surgery because of the structure of the tendon. Tendon injuries can occur due to infection, trauma, or sudden rupture. There are 3 types of tendon repair: primary, delayed primary, or secondary.
- Primary repair of an acute or sudden injury is often done within 24 hours of the injury. This is usually a direct surgery to fix the injury.
- Delayed primary repair is usually done a few days after the injury, but while there is still an opening in the skin from the wound.
- Secondary repairs may occur 2 to 5 weeks or longer after the injury. They may include tendon grafts. This is when tendons from other areas of the body are inserted in place of the damaged tendon. Or other more complex procedures may be used.
Nerve repairs
An injury can damage the nerves in the hand. This can cause a loss of hand function and a loss of feeling in the hand. Some nerve injuries may heal on their own. Others may require surgery. Generally, surgery is done about 3 to 6 weeks after the injury. This is the best time for nerve repairs that are linked with other more complicated injuries.
In cases where nerve damage is not linked to more complicated injuries, surgery to check the damaged nerve is usually done soon after the injury. This increases the chance of a full recovery. If the nerve is cut or severed, it may be fixed by reattaching it to the other end of the nerve. Or a nerve graft may be done. This involves replacing the damaged nerve with nerves taken from other areas of the body.
Fasciotomy
This procedure is done to help treat compartment syndrome. This painful condition occurs when there is swelling and increased pressure in a small space, or compartment, in the body. Often this is caused by an injury. This pressure can interfere with blood flow to the body tissues and destroy function. In the hand, a compartment syndrome may cause severe and increasing pain and muscle weakness. Over time, it can cause a change in color of the fingers or nailbeds.
For a fasciotomy, your doctor will make a cut or incision in your hand or arm. This decreases the pressure, lets the muscle tissue swell, and restores blood flow. Any tissue inside the area that is already damaged may be removed at this time. This procedure helps prevent any further damage and decrease in function of the affected hand.
Surgical drainage or debridement
Hand infections are very common. Treatment for hand infections may include rest, using heat, elevation, antibiotics, and surgery. If there is a sore or abscess in the hand, surgical drainage may help remove any pus. If the infection or wound is severe, debridement may be used to clean dead and contaminated tissue from the wound. This prevents further infection and helps promote healing.
Joint replacement
This type of surgery, also called arthroplasty, is used in cases of severe hand arthritis. It involves replacing a joint that has been destroyed by arthritis with an artificial joint. This artificial joint may be made of metal, plastic, silicone rubber, or your own body tissue, such as a tendon.
Replantation
This type of surgery reattaches a body part, such as a finger, hand, or toe, which has been completely cut or severed from the body. The goal is to restore as much function as possible. Replantation uses microsurgery. This is a complex type of surgery that uses tiny tools and is done under magnification using a microscope. In some severe cases, more than 1 surgery may be needed.
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:
- Infection
- Incomplete healing
- Loss of feeling or movement of the hand or fingers
Treatment of carpal tunnel syndrome
Your health care provider will figure out the best treatment for you based on:
- Your age
- Your overall health and medical history
- How bad your wrist is right now
- How well you tolerate specific medications, procedures, or therapies
- How bad the disease is expected to get
- Your opinion or preference
Treatment may include:
- Splinting your hand. This helps keep your wrist from moving. It also eases the compression of the nerves inside the tunnel.
- Anti-inflammatory medication. These may be oral or injected into the carpal tunnel space. These reduce the swelling.
- Surgery. This eases compression on the nerves in the carpal tunnel.
- Worksite changes. Changing position of your computer keyboard or making other ergonomic changes can help ease symptoms.
- Exercise. Stretching and strengthening exercises can be helpful in people whose symptoms have gotten better. These exercises may be supervised by a physical or occupational therapist.
Scar Revision
Scar revision surgery helps minimize scars so that they can blend better with surrounding skin. Scars may be raised or recessed and of different color and texture from normal tissue. Facial and other noticeable scars (including burn scars, keloid scars, and hypertrophic scars) usually require one of several surgical correction techniques. Minor scars, on the other hand, can often be treated with minimally invasive treatments like laser resurfacing or Dysport/Botox injections. Keep in mind that many surgeons advise against scar revision for up to a year after an injury to give the body time to heal.
Congenital Hand Deformities
What are congenital hand deformities?
Congenital anomalies are deformities that are present at birth. Any type of deformity in a newborn can become a challenge for the child as he or she grows. Hand deformities can be particularly disabling as the child learns to interact with the environment through the use of his or her hands. The degree of deformity varies from a minor deformity, such as unequal fingers, to a severe deformity, such as total absence of a bone.
Early consultation with your plastic surgeon, Dr. Roth, is an important part of the treatment process for the child born with a hand deformity. Even if reconstructive surgery is not possible, there are many different types of prosthetic devices that can be used to increase function.
What are the different classifications of congenital hand deformities?
The classifications for hand deformities can vary. This classification has been accepted by the American Society for Surgery of the Hand. There are currently 7 groups of deformities of the hand:
Problems in the formation of the parts
This occurs when parts of the body stop developing while the baby is in the womb. This causes either a complete absence of a part of the body, such as the hand, or a missing structure, such as part of the arm bone. In the case of the complete missing part, surgery is not done. Instead, these children may get prosthetic devices early in their childhood. Types of these classifications include:
- Radial clubhand. A radial clubhand is a deformity that involves all of the tissues on the thumb side (radial side) of the forearm and hand. There may be shortening of the bone, a small thumb, or absence of the thumb. Deformities of the wrist are usually operated on around 6 months of age.
- Ulnar clubhand. An ulnar clubhand is less common than a radial clubhand. This deformity may involve underdevelopment of the ulnar bone (the bone in the forearm on the side of the little finger), or complete absence of the bone.
Failure of parts of the hand to separate
With this type of deformity, the parts of the hand, either the bones or the tissues, fail to separate in the womb. The most common type of this classification is syndactyly. Syndactyly is when 2 or more fingers are fused together. There is a familial tendency to develop this deformity. If the fingers are completely fused together, it is considered complete. There are 2 types of syndactyly:
- Simple syndactyly. This involves fusion between only the tissues of the fingers.
- Complex syndactyly. This involves fusion between the bones.
Another example of failure of the hand to separate is seen in contractures of the hand. Contractures of the hand may also develop as a result of a problem with the cells in the womb. A contracture is an abnormal pulling forward of the fingers of the hand. It is usually caused by problems with the muscles or skin. One of the common types of this classification includes congenital triggering. Congenital triggering occurs when one of the fingers is unable to extend. It is usually seen in the thumb. It may take some time in the child’s development before it is noted that the child can’t extend the thumb. Some of these cases improve on their own. Surgery is usually not done until the second year of life, but preferably before the age of 3.
- Duplications of fingers. Duplication of fingers is also known as polydactyly. The little finger is the finger that is most often affected.
- Undergrowth of fingers. Underdeveloped fingers or thumbs are associated with many congenital hand deformities. Surgical treatment is not always required to correct these deformities.
Underdeveloped fingers may include the following:
- The finger is small
- Muscles are missing
- Bones are underdeveloped or missing
- There is complete absence of a finger
Overgrowth of fingers
Overgrowth of fingers is also known as macrodactyly, which causes an abnormally large finger. In this situation, the hand and the forearm may also be involved. In this rare condition, all parts of the finger (or thumb) are affected; however, in most cases, only one finger is involved (usually the index finger). Surgical treatment of this condition is complex and the outcomes may be less than desirable. Sometimes, amputation of the enlarged finger is recommended.
Congenital constriction band syndrome
This occurs when a tissue band forms around a finger or arm, causing problems that can affect blood flow and normal growth. Ring constrictions are congenital (present at birth). This condition may be associated with other birth defects, such as clubfoot, cleft lip, or cleft palate. The cause of the ring constrictions is unknown. Some theories suggest that amniotic banding may lead to ring constrictions around a finger or limb. In a few cases, the finger may need to be amputated. Other generalized problems with the skeletal system are a rare and include a complex group of problems.
Treatment for congenital hand deformities
- Specific treatment for congenital hand deformities will be determined by your child’s doctor based on:
- Your child’s age, overall health, and medical history
- Extent of the condition
- Cause of the condition
- Your child’s tolerance for specific medications, procedures, or therapies
- Expectations for the course of the condition
- Your opinion or preference
Treatment may include:
- Limb manipulation and stretching
- Splinting of the affected limbs
- Tendon transfers
- External appliances (to help realign misshapen fingers or hands)
- Physical therapy (to help increase the strength and function of the hand)
- Correction of contractures
- Skin grafts. These involve replacing or attaching skin to a part of the hand that is missing skin or has been removed during a procedure.
Prosthetics. These may be used when surgery is not an option, or in addition to surgical correction.
Recovery from hand surgery
Recovery from hand surgery can be lengthy, depending on your particular procedure. Dr. Roth provides complete guidance throughout the healing process. On the first night after your surgery, he will call you to answer questions and check on your progress. He will remain available to address any concerns you have in the following days. In many cases, you will require physical therapy to restore your hand’s strength and range of motion. Dr. Roth can refer you to an outstanding local therapist, and he will continue to monitor your progress through routine check-ups.
