Clinical Specialties

Hand Surgery

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What is hand surgery?

Hand surgery is a broad term that covers many different types of procedures. It is a multidisciplinary field that treats a wide array of disorders involving soft tissue and bone injuries that impair the strength, function and flexibility of your hand, wrist, fingers, and elbow. Hand specialists receive specialized training in the treatment of hand problems beyond their board certified specialty training in orthopedic surgery, plastic surgery, or general surgery. CareMount Medical has a team of fellowship-trained surgeons who specialize in hand surgery for the evaluation, diagnosis and treatment of both simple and complex conditions.

Which conditions may require surgery?

Hand surgery may be done for many reasons, including:

  • carpal tunnel syndrome
  • tennis elbow
  • wrist pain
  • sports injuries of the hand and wrist
  • fractures of the hand, wrist, and forearm
  • trigger finger

Other problems treated can include arthritis, nerve and tendon injuries, and congenital limb differences (birth defects).

Some of the most effective treatments do not require surgery—they involve hand therapy and the use of several types of splints. When surgery is necessary, the latest and most sophisticated techniques are used.

At CareMount Medical, our hand surgeons are trained in the most current techniques and focus on providing our patients with expert care while minimizing discomfort, improving function and enhancing quality of life.

What are the different types of hand surgery?

Many different types of surgeries can be performed on the hand depending on the cause of the problem. These procedures include:

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.

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.

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.

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.

Hand Surgeons:
Simon H. Chin, MD
Ogheneochuko Metitiri, MD
Donato Perretta, MD
Alan J. Schefer, MD