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Hand Surgery
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Description

A range of procedures to restore the function of the hand, and to maximize the cosmetic appearance of the hand.


Length of Surgery

1 – 2 hours


In/Outpatient

Outpatient


Anesthesia

Depending on the extent and complexity of the hand surgery - regional; local, with or without IV sedation; general anesthesia.


Back to work in...

1 – 4 weeks


Back to the gym in...

4 – 6 weeks


Treatment Frequency

Several hand surgeries may be needed over a period of time to obtain optimal results in some cases.


Risks

  1. Infection
  2. Poor healing – especially if you smoke
  3. Loss of feeling or movement of the hand and fingers
  4. Blood clots
  5. Allergic reaction to the anesthesia
  6. Poor healing
  7. Hematoma (a collection of blood under the skin)
  8. Significant bruising

Duration of results

Permanent



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Click links below for detail.




Hand Surgery Costs*

Hand surgery costs can vary widely from surgeon to surgeon, due to a number of factors. A board certified, experienced hand surgeon will charge more, but when having delicate and complex surgery of this nature, it is advisable to choose a surgeon with a great deal of specific experience in hand surgery. The total cost will also depend on the length and complexity of the hand surgery procedure, the region in which the hand surgery is performed, and other additional costs such as anesthesia fees, facilities fees, medication costs etc.

Ensure that you agree a total hand surgery cost with the hand surgeon prior to undergoing any surgical procedure, to make sure that you are not subject to any hidden fees after you have had your hand surgery operation.

Most plastic surgeons and surgical clinics offer flexible hand surgery financing and payment options, some of which allow staggered payments or loans from VARIOUS FINANCING COMPANIES.

If you are considering having hand surgery but want to explore more about the financing options available before you make your decision, PLEASE CLICK HERE. You can discuss your financial options with your surgeon, and find out if there are any loans of flexi-payment plans available to you. To find out more about financing options available please click here.
 

Am I a candidate for hand surgery?

The best candidates for hand surgery are those who are under a great deal of distress caused by hand injuries; carpal tunnel syndrome; rheumatoid arthritis; Dupuytren's contracture or congenital defects.

You may be a good candidate for hand surgery if:

  1. You are not overweight
  2. You are physically healthy and emotionally stable
  3. You exercise regularly
  4. You don't smoke
  5. You do not drink heavily
  6. You have realistic expectations about your hand surgery
  7. You understand the risks, side effects and potential complications of hand surgery
You may not be a good candidate for hand surgery if you have:
  1. Diabetes
  2. Hypertension
  3. A bleeding disorder
  4. Heart or lung disease
  5. Obesity
  6. Severe allergies
  7. Elevated cholesterol
  8. Arthritis
  9. Depression
  10. You smoke or drink heavily
  11. A connective-tissue disease
  12. Areas of damaged skin from radiation therapy
  13. Decreased circulation to the surgical area
  14. HIV or an impaired immune system
If you suffer from any of these health problems you face a higher rate of surgery complications such as infection, bleeding, skin loss, and problems due to the anesthesia.

Ensure that in your initial hand surgery consultation, you are honest with the hand surgeon about your medical history and lifestyle. Your hand surgeon will be able to evaluate whether you are a good candidate for hand surgery once he or she has a complete picture of your physical and psychological health.

 

What is a hand surgery Procedure?

Hand surgery is a broad term that incorporates a vast array of different types of surgery on the hand, wrist, and forearm. Plastic surgeons who perform hand surgery attempt to restore not only the function of the hand, but also try to maximize the cosmetic appearance of the hand. Examples of conditions treated by a hand surgeon are: carpal tunnel syndrome ; wrist pain ; cuts on the fingers and hand ; sports injuries to the hand and wrist ; deformities of the hand.

A hand injury is as unique as a set of fingerprints. If you have pain in your fingers, hand, wrist or arm, or have other upper-extremity related concerns, you may want to consult a hand surgeon. Whether the defect is congenital or acquired, hand plastic surgeons can usually restore comfort, mobility, and a normal hand appearance to patients with hand problems.

Hand surgery can be performed for many conditions, including:

  1. Arthritis (Osteoarthritis, Rheumatoid arthritis)
  2. Burns
  3. Cuts
  4. Congenital defects
  5. Dupuytren’s contracture
  6. Fractures
  7. Ganglion cysts
  8. Infection
  9. Nerve and tendon damage
  10. Reattachment after amputation
  11. Repetitive use injuries (Carpal tunnel syndrome)
  12. Tendonitis
  13. Trigger finger
  14. Tumors
A typical hand surgery operation is performed as a day-case under a regional anaesthetic; local anesthetic; local anesthetic and sedation, or occasionally under general anesthesia. An overnight stay in hospital are unusual but sometimes may be required for some hand operations, such as in children or when surgery is extended. Depending on the condition/injury to be treated, several hand surgeries may be required to give you the best possible results. Post-operative treatment and rehabilitation by a hand therapist is essential for optimal recovery after some types of hand surgery.

The surgeon uses fine instruments to handle the delicate structures in the hand, and may use magnifying glasses or an operating microscope for repair of the small nerves and arteries in the hand. When opting to have hand surgery, it is essential to consult a highly experienced and reputable hand surgeon who has specific experience in this delicate and complex type of plastic surgery.

Hand surgery may be practiced by graduates of general surgery, orthopedic surgery and plastic surgery. Plastic surgeons and orthopedic surgeons receive significant training in hand surgery during their residency training, with some graduates continuing on to do an additional one year hand fellowship to become members of the American Society for Surgery of the Hand. Hand plastic surgeons are trained to reconstruct all aspects to salvage the hand, i.e. to repair and or reconstruct blood vessels, nerves, tendons, muscle and bone. Many hand surgeons are also experts in diagnosing and caring for shoulder and elbow problems.

When a problem takes place in the hand, care must be given to all the different types of tissues that make function of the hand possible. Sometimes hand surgeons will recommend non-surgical treatment options, or may refer you to a hand therapist for more treatment.

Reconstructive hand surgery is the procedure by which form and function of the hand is restored after injury (such as burns or crushed parts of the hand), disease (such as severe arthritis, carpal tunnel syndrome, tennis elbow, Dupuytren's Contracture, and tendonitis), or deformity (i.e. webbed, short, curved or extra fingers). Reconstructive hand surgery may be necessary in cases where injury, congenital deformity, or disease cause significant harm or inhibits the normal hand use and functioning. Reconstructive hand surgery may involve reconstructing, repairing or replacing different parts of the hand including bones, muscles, tendons, joints and skin.

Hand surgery procedures to treat these types of injuries include resetting and repairing dislocations and fractures, repairing nerves and tendons, caring for burns, and reattaching missing digits. After the initial repairs are complete, full reconstructive hand surgery may also include replacement of hand skin through skin grafting, skin and muscle flap procedures, and microsurgical reconstruction of skin, muscle, bone, or nerve by means of tissue transplantation.

Congenital hand deformities can also benefit from reconstructive hand surgery. Children who are born with webbed fingers (syndactyly) can undergo reconstructive hand surgery around the age of six months to prevent permanent deformities and to allow normal development of hand function. Reconstructive hand surgery can also treat missing, extra, short, curved, or deformed fingers.

Most hand surgery is done on an outpatient basis under a local, regional or a general anesthesia. Physical therapy is often an essential part of the recovery process. Reconstructive hand surgery recovery time can very depending on the nature of the injury. Your hand plastic surgeon will discuss recovery time, risks and complications, and the likely results of hand surgery with you prior to the hand surgery procedure.

The size, nature and extent of your hand injury or deformity will determine what hand surgery treatment option is chosen and how quickly the surgery will be performed. Reconstructive hand surgery needs complex planning and may require a number of procedures done in stages.

 

Hand Surgery Procedure Steps

In some cases of hand surgery, more than one hand surgery operation is required over an extended period of time. There are many different hand surgery procedures, and individual surgical practice may vary.

Step 1 – Anesthesia

Depending on the hand surgery procedure to be performed, the patient will receive:

Local anesthesia

  1. This may include injecting numbing medicine into the finger, or only at the site of the hand surgery. Sedative medications may also be given through an intravenous line to make you drowsy and help you relax during your surgery.
General anesthesia
  1. If you are given general anesthesia you will be asleep during the hand surgery operation.
Regional anesthesia
  1. (“Nerve Blocks or “Arm Blocks”) - Regional anesthesia puts part of your body to sleep by injecting numbing medicine through a needle along the path of nerves. This may be around the collarbone, under the arm, or through an intravenous line placed in your arm. There are several different types of regional anesthesia depending on the area to be operated on.
Step 2 – The surgery

There are many different types of hand surgery, and the following is an overview :

Skin grafts
  1. Skin grafts involve replacing or attaching skin to a part of the hand that has missing skin. The most common type of injury requiring a skin graft is fingertip amputations or injuries. Skin grafts are performed by taking a piece of healthy skin from another area of the body (called the donor site) and attaching it to the damaged area.
Skin flaps
  1. Skin flaps are much like skin grafts. However, with a skin flap, the skin that is retrieved has its own blood supply. Underlying blood vessels, fat, and muscles make up the section of skin used. Skin flaps may be used when an area that is missing the skin does not have a good supply of blood because of the location, damage to the vessels, or extensive damage to the tissue.
Closed reduction and fixation
  1. This type of procedure is used when there is a fracture in part of the hand, including the fingers. This type of hand surgery re-aligns a fractured bone and then immobilizes the area at the time of healing with internal fixtures such as wires, rods, splints, and casts.
Nerve repairs
  1. The hand has three main nerves - the ulnar nerve, the median nerve, and the radial nerve. Injuries involving the hand may cause damage to these nerves that may result in decreased ability to mobilize the hand and experience feeling. While some injuries heal on their own, others will need hand surgery. In severe cases, the nerve may be corrected by reattaching it directly to the other end of the nerve, or by performing a nerve graft.
Fasciotomy
  1. This procedure treats compartment syndromes. A compartment is a three-dimensional space in the body surrounded by fascia or bone which contains arteries, nerves and veins. A compartment syndrome is a condition that arises when intracompartmental tissue pressure increases, usually brought about by trauma, which can hamper the circulation to the body tissues, cause severe and increasing pain and muscle weakness and destroy hand function. Surgical incisions are placed in the hand or arm to allow a release of the pressures that are increasing inside the body. Any tissue inside the body that is already damaged may also be removed at the same time.
Joint replacement (arthroplasty)
  1. This type of hand surgery may be used in people with severe arthritis in the hand. This hand surgery involves replacing a joint that has been destroyed by the progress of the disease with an artificial joint made out of metal, plastic, silicone rubber, or the patient's own body tissue.
Replantation
  1. This type of hand surgery replaces fingers or hands that have been amputated, usually through some type of trauma. Replantation uses microsurgery, an intricate and precise hand surgery that is performed under magnification. Some severe injuries may require more than one surgery to achieve the best results.
Step 3 – The results
  1. The hand surgery operation site will be sutured after your hand surgery, a splint or internal fixture(s) may be used to support the areas that have been operated on, e.g. the digits, and the hand will be bandaged. You will probably need hand therapy after any type of hand surgery to restore movement and give you the fullest possible use of your hand.

 

Hand Surgery Recovery and Healing Steps

The hand is an extremely sensitive part of the body, and you may have swelling and mild to severe pain following hand surgery. Your hand doctor can prescribe injections or oral medication to make you feel more comfortable. It is also common to experience numbness and tingling in the hand for eight to ten hours or longer after hand surgery.

You may be restricted from work and specific activities, and your hand will probably need to be immobilized in a bandage or splint. How long your hand must remain immobilized and how quickly you resume your normal activities depends on the type and extent of your hand surgery and on your own healing abilities.

To enhance your recovery and give you the fullest possible use of your hand, your hand doctor will probably recommend a course of rehabilitation (physical and occupational therapy) under the direction of a trained hand therapist for strength building and improved functioning of your hand. Your hand therapy may include hand exercises, heat and massage therapy, electrical nerve stimulation, managing scars, splinting, traction, and special wrappings to control swelling. After you go home from the hospital, you will need physical therapy from three to six times a week for three to six weeks.

It is vitally important to your hand surgery recovery that you follow the hand therapist's instructions and complete the entire course of therapy in order to regain the maximum use of your hand.

The surgical dressing is normally removed after two or three days, and stitches are usually removed ten to fifteen days after hand surgery.

Elevation of the hand is very important after any hand surgery. The hand should be kept at a level higher than your heart to help fluid to drain from the hand, which is very important to help prevent swelling. If you hand becomes swollen, it will be painful and stiff. It is important to make a full fist and fully straighten your fingers ten times an hour after any hand surgery or injury that does not involve a tendon repair. This helps to pump the fluid out of the fingers and further prevent swelling. Apply ice directly over the hand bandage for 15 minutes every 1-3 hours while you are awake until your follow up appointment or as long as there is pain and swelling. Keep away from hot, sharp or moving objects. Due to the loss of sensation in your arm you may be at risk of burns or further injuries until normal sensation returns.

You must keep your bandages dry – try showering with a large plastic bag taped securely over the hand and arm and keep your hand elevated.

You should be able to drive again three days to two weeks after hand surgery. Arrange for someone to drive you home after your hand surgery operation and if possible, to stay with you for about a week. You will need someone to help you out with preparing food etc for several weeks after discharge. Depending on the extent of your hand surgery, you should be able to return to sedentary work one to four weeks after surgery.

Hand surgery Side Effects and Surgery Risks

Thousands of successful hand operations are performed each year and the procedures are generally safe when performed by a qualified and experienced plastic surgeon. However, as with any surgery, hand surgery risks are possible and complications can arise.

Hand surgery side effects are inevitable, and these may include:

  1. Swelling
  2. Moderate to severe pain
  3. Tingling and numbness in the hand
  4. Loss of sensation in the arm for 18-24 hours after the hand operation – this is normal and feeling should return once the anesthetic has worn off
The possible complications of any hand surgery may include:
  1. Infection
  2. Poor healing – especially if you smoke
  3. Loss of feeling or movement of the hand and fingers
  4. Blood clots
  5. Allergic reaction to the anesthesia
  6. Hematoma ( a collection of blood under the skin)
  7. Significant bruising
These complications are infrequent, however, and they can generally be treated. Individuals vary greatly in their anatomy and healing ability and the outcome is never completely predictable. However, you can reduce your risks and chance of suffering complications by choosing a qualified surgeon and by closely following his or her instructions both before and after hand surgery.

If you notice any of the following, call your doctor immediately:
  1. Drainage or bleeding from the incision
  2. Redness around the incision
  3. Fever over 100 degrees
  4. Increased swelling

 

Questions to Ask a Surgeon About a hand surgery procedure

Knowledge is power so arm yourself with the facts before making any decision about hand surgery. Here is an essential check list to help you find the right Perfect Yourself Surgeon.

  1. Am I a good candidate for hand surgery?
  2. Are my described expectations realistic?
  3. Where is the surgery performed?
  4. How long will the procedure take?
  5. What kind of anesthesia is used?
  6. What is your experience in performing hand surgery?
  7. Can I see your qualifications?
  8. Ask to see any hand surgery before and after photographs of recent surgeries?
  9. What percentages of your hand surgery patients have had significant post-surgical complications? (surgeons should disclose this information to you)
  10. Who will be assisting my surgery? Can I see their qualifications?
  11. How much will my hand surgery cost?
  12. Do you offer patient financing? (Flexible payment schemes for your surgery)
  13. Will you repeat/correct procedures if the agreed goals are not met? If this is the case, will I be charged again?
  14. Ask to observe the exact procedure you are considering before you decided to have surgery if you are unsure (this could be on videotape or in real life).
  15. What is the recovery and healing period for hand surgery?
  16. When can I resume full normal activity?
  17. Have you ever had your malpractice insurance coverage denied, revoked, suspended?
  18. Ask for and follow up on patient references (these can be invaluable to finding out what your surgeon is really like and the level of customer satisfaction he/she has received in the past)

 

Surgeon Checklist

Surgeon Checklist

Knowledge is power so arm yourself with the facts before making any decision about Hand Surgery procedures; click here for an essential check list to help you find the right Perfect Yourself plastic surgeon.


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