Hand surgery is a separate subset of surgery dealing with the bones tendons and soft tissue of the hand. Physiotherapy is an important part of hand surgery. Reconstructive surgery of the hand is necessary for post-burn contractures, post-trauma deformities, and congenital defects.
SOFT TISSUE INJURIES
Injuries of the hand need to be evaluated carefully. Though the injury may seem to be minor improperly treated nailbed and hand injuries can cause significant distress to the patient.
Hand Fractures are common injuries. These can be treated in different ways like splinting, k-wiring, screws, mini plates, wires, external fixators etc. The kind of fixation depends on the location and type of fractures.
Tendon injuries are common when the hand is injured by a sharp object. Though the external injury may seem innocuous, the damage caused may be severe. This kind of injuries needs careful surgery, prolonged immobilization, and physiotherapy for good results.
Nerve injuries are best treated at the time of injury itself, however, if the treatment is delayed then nerve grafting is most likely to be needed. Nerve injuries treated by nerve grafting usually have a protracted recovery. The nerve for grafting is usually harvested from the leg.
Whenever there is a loss of tendon or a long delay in treating a tendon injury, a tendon graft is necessary. It involves replacing the tendon gap by surgery and a prolonged course of splintage and physiotherapy.
Thumb and finger reconstructions
Loss of a thumb or a digit can be quite a devastating injury. Reconstructions of the thumb or fingers are possible through toe transfers, osteoplastic reconstructions, transfer of the neighboring digits to the thumb, the distraction of the existing one, all to give a good reconstruction. Post-burn deformities are also common on the thumb or the digits of the hand. Deep burns of the hand cause scarring and can restrict the function of the hand. Timely surgery can alleviate such problems. Like all other hand surgeries, compression splintage and physiotherapy form an integral part of the treatment of these conditions.
Post-burn deformities are common. Deep burns of the hand cause scarring and can restrict the function of the hand. Timely surgery can alleviate such problems. Like all other hand surgeries compression splintage and physiotherapy form an integral part of the treatment of these conditions.
Peripheral Nerve Surgery
Surgery on the peripheral nerves is done with magnification. The treatment may be prolonged and may need more than one procedure. The common injuries that occur are injuries of the nerves in the limbs especially the upper limbs. Early surgery of the nerves gives good results. In some cases, with a loss of nerve length nerve grafting may be necessary. In certain situations, wherein the patient is seen very late, muscle or tendon transfers may be necessary to restore function.
BRACHIAL PLEXUS INJURIES
Brachial plexus injuries are some of the more devastating injuries. Road traffic accidents due to a two-wheeler accident are the overwhelming cause of these injuries. A brachial plexus is a group of five major nerves that together supply the upper limb. Damage to this plexus can lead to a totally flail upper limb. The treatment for these injuries involves a careful clinical examination, appropriate investigations at the correct time and timely surgery. The pattern of injury will dictate the type of surgery that has to be performed. Necrolysis, nerve repair, nerve grafting, nerve transfers, muscle transfers, and free functional muscle transfers are some of the commonly done surgeries for this condition. Sometimes the brachial plexus can get damaged at birth leading to Obstetric Brachial Plexus Palsy. The spectrum of this disease is wide and can cause varying degrees of deformity. Surgery on these children can help to minimize the consequences of this deformity.
Burns comes with devastating consequences. Appropriate timely treatment can reduce the effect of these consequences. Burns caused by heat, electricity or chemicals are known as thermal burns, electrical burns or chemical burns, respectively. Burns can be life-threatening injuries. They can cause fluid and electrolyte disturbances, renal failure, respiratory failure or sepsis which all can lead to death. They can be of various depths. Depending on the depth of the burn, it can even cause damage and scarring during healing. The location and type of scarring will decide the deformity or contractures due to the burns. While it is not possible to completely remove the scarring, it is definitely possible to alleviate the suffering of these patients to a significant extent. Various surgical methods like skin grafts, tissue expander flaps, etc can be used. The use of pressure garments splints and frequent massages will help these scars.