Types of Hand Surgery

What is hand surgery?

There are many types of hand surgery. Plastic surgeons who do hand surgery aim to restore hand and finger function. But they also try to make the hand look as normal as possible. Hand surgery may be done for many reasons, including:

• Hand injuries

• Rheumatic diseases, such as osteoarthritis and rheumatoid arthritis, that change and damage parts of the hand

• Degenerative changes to parts of the hand

• Problems or defects that are present at birth (congenital)

• Infections

Understanding different types of hand surgery

Many different types of surgery can be done on the hand. It depends on the type and cause of the problem. These procedures include:

Skin grafts

Skin grafts are done by 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. A piece of healthy skin is taken from another part of the body, called the donor site, and attached to the injured area.

Skin flaps

Like a skin graft, a skin flap is done by 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 blood vessels, fat, and muscles. Flaps may be used when an area that's missing skin doesn't have a good blood supply. This may be because of the location, damage to the vessels, or amount of tissue damage.

Closed reduction and fixation

This may be used when there is a broken bone (fracture) in part of the hand, including the fingers. This type of surgery realigns the broken bone (reduction) and then holds it in place (fixation) while it heals. Fixation can be done with fixtures such as 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. Tendons take longer to heal due to limited blood supply. Tendon injuries can occur due to infection, injury, or sudden rupture. There are 3 types of tendon repair:

• Primary repair. This is surgery for a sudden (acute) injury. It's often done within 24 hours of the injury. This is often a direct surgery to fix the injury.

• Delayed primary repair. This is often done a few days after the injury, but while there's still an opening in the skin from the wound.

• Secondary repairs. These may occur 2 to 5 weeks or longer after the injury. They may include tendon grafts. This is when tendons from other parts 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 complex injuries.

In cases where nerve damage isn't linked to more complex injuries, surgery to check the damaged nerve is often 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 is done by 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 (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, 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 healthcare provider will make a cut (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's already damaged may be removed at this time. This procedure helps prevent more damage and loss of function of the affected hand.

Surgical drainage or debridement

Hand infections are very common. Treatment for hand infections may include rest, using heat, keeping the hand raised (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 done. This is the cleaning of dead and contaminated tissue from the wound. This prevents an infection from getting worse and helps aid healing.

Joint replacement 

This type of surgery, also called arthroplasty, is used in cases of severe hand arthritis. It is done by replacing a joint that has been destroyed by arthritis or injury 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 is done with 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 has the risks of anesthesia and bleeding. Other risks depend on the type of surgery being done. They may include:

• Infection

• Incomplete healing

• Loss of feeling or movement of the hand or fingers

• Blood clots

• Joint stiffness or reduced range of motion