Hand surgery: your questions answered

In her latest online article, renowned plastic, cosmetic and hand surgeon Miss Kerstin Oestreich answer your most frequently asked questions regarding hand surgery. She explains the different techniques and approaches and what is taken into consideration prior to the surgery, among many other interesting points.

What are the most common types of hand surgery performed by plastic surgeons, and what conditions or injuries do they typically address?

Hand surgery can be performed by either plastic surgeons or orthopaedic surgeons, and the procedures offered may vary slightly between the two. In general, plastic surgeons who specialise in hand surgery focus more on soft tissue issues. These can include treating conditions such as trigger fingers, tendon repairs, nerve compression syndromes, or reconstruction after traumatic injuries that result in significant soft tissue loss. Plastic surgeons also address both functional and aesthetic aspects related to hand surgery. Additionally, plastic surgeons often treat children with congenital hand differences, where the hand has not formed normally, leading to missing or fused fingers.

What factors are taken into consideration when determining a patient's suitability for hand surgery?

When it comes to hand surgery, the decision on the appropriate type of surgery is unique compared to other procedures. Several factors are considered, such as the patient's age, their daily hand usage (including their profession and hobbies), their dominant hand, and any specific activities like playing musical instruments or participating in sports.

These factors play a significant role in determining the type of surgery and the expected recovery process, and they are crucial to discuss with the patient before making decisions about hand surgery.

What techniques or approaches are utilised in hand surgery procedures to achieve optimal outcomes?

Hand surgery procedures require a delicate approach, even in adults, as the structures, including nerves and vessels, are very small. To ensure precision during surgery, a bloodless operation field is necessary. This is achieved by using a tourniquet, which is essentially a blood pressure cuff placed around the upper arm to restrict blood flow to the hand during the procedure.

Alternatively, a newer technique called Walant involves injecting local anaesthetic with adrenaline to reduce blood supply to the operation field. Additionally, loop magnification is often used, either through a specific pair of glasses or a microscope, to ensure a clear view of the tiny structures involved in the surgery. Meticulous dissection is essential for achieving optimal long-term outcomes and successful recovery.

What are the potential risks of complications associated with hand surgery, and how are they managed and minimised?

One of the main concerns in hand surgery is post-operative swelling, which can lead to joint stiffness. To minimise this risk, surgeons focus on meticulous dissection and minimising bleeding during the procedure. Patients are advised on how to prevent swelling by elevating their hand post-operatively. Dedicated hand therapy tailored to the type of surgery is crucial to ensure proper recovery.

Another risk, though rare, is chronic regional pain syndrome, which causes prolonged pain and swelling in the hand. If this occurs, intensive hand therapy and potentially medication are used to manage the pain and aid in long-term recovery. Adhering to proper hand surgery guidelines can help minimise these risks.

What is the typical recovery process after hand surgery, including postoperative care, rehabilitation, and the expected timeline for restoring hand function?

Recovery after hand surgery can vary widely depending on the type of procedure performed. For minor procedures like ganglion removal or trigger finger release, recovery may be as short as two weeks. However, more extensive surgeries, such as joint replacements or major reconstructions after trauma, may require three to six months for full hand function to be restored.

It is crucial for the surgeon to discuss the expected recovery time with the patient before the surgery so they can plan their activities and work accordingly. Hand therapy plays a significant role in the recovery process, and patients are advised to follow the instructions of the surgeon or hand therapist diligently. Proper postoperative care, including hand elevation and avoiding overexertion, is essential for a successful outcome in most cases.

Miss Kerstin Oestreich is a renowned plastic, cosmetic and hand surgeon based in Birmingham. If you would like to book a consultation with Miss Oestreich, you can do so today via her Top Doctors profile.