Hand Surgery

Hand Surgery

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At Athera, our expert Dr. Ujwal Chirde, will examine you and discuss your options for better results for Hand Surgery.

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Hand is organ of function with very complex anatomy. It consists of 27 bones various nerves, arteries, veins, muscles, tendons, ligaments, joint cartilage and finger nails. Any injury to underlying structures of hand carries the potential for serious handicap. To reduce this risk, even the smallest hand injuries (either blunt or sharp injuries) require proper surgical evaluation.Also, different hand deformities (Congenital, Burns, Leprosy, etc) and swelling over the hand (Lipoma, Ganglion, etc) will require Plastic surgery management.

What is the role of Plastic Surgeon in Hand injury?

Injuries that involve tendons, nerves and arteries require delicate repair under magnification which can be treated by Plastic Surgeons with good results. Many injuries can be missed or overlooked by the primary care provider as very tiny structures of hand are difficult to identify. Hand injuries if not treated can lead to functional restriction or prolong morbidity. Damage to arteries can lead to loss of limbwhile missed nerve injury leads to loss of movement and sensation. A missed Brachial plexus injury may lead to insensate and useless limb with severe pain.

What are different types of Hand injury?

Hand injuries can be major or minor cuts, fractures, dislocation, soft tissue injury, amputation, infection, burns, brachial plexus injury and high pressure injury (grease and paint guns). Other common Hand injuries include Nail injuries, finger injuries, finger infection and wrist injuries.

What other case scenarios which require Hand surgery by plastic surgeon?

  • Lipoma over the hand
  • Ganglion
  • Carpal Tunnel syndrome (pinched nerve in the wrist)
  • Trigger finger (finger gets stuck in bent position)
  • Dupuytren’s contracture (one or more fingers stay bent towards palm)
  • Camptodactyly and Clinodactyly (Flexed or bent fingers)
  • Birth defects (Syndactyly, Polydactyly, etc)
  • Leprosy related hand deformity (Claw hand)
  • Burn deformity of hand

When to seek emergency care by Plastic surgeon?

  • Severe pain and bleeding, numbness, loss of motion or strength
  • Complete separation of injured part from rest of the hand (amputation)
  • Signs of infection (redness, swelling, pus or fever)
  • Exposure of underlying structure such as tendons, bone, joints, artery, vein or nerve
  • Any deep cut, open or dirty wound or wounds due to animal or human bite
  • Burns: If the skin is disrupted or if the burn goes completely around a finger, hand or wrist

What kind of treatment is offered in Hand injury by Plastic surgeon?

Plastic surgeon make diagnosis after history and physical examination. Some injuries will require X-ray to identify fractures or dislocation or to rule out foreign bodies. In Brachial plexus injury MRI and EMG-NCV are advised occasionally. Tendons, muscles, nerve, artery are repaired individually and hand is kept in splint. After surgery physiotherapy plays very important part of treatment. Fractures and dislocations are treated by wire, plates or screw fixation. Infection with abscess is treated by incision and drainage and medication.

What is the meaning of replantation and revascularization?

Replantation is reattachment of part of a hand that has been completely amputated- No connection exists between cut part and the patient.

Revascularization is repair of a part that has been incompletely amputated- some of soft tissue (skin, nerve or tendon) is intact but there is no blood supply to hanging part. It is as difficult as replantation.


Most of major Hand injuries will need close follow up with Plastic surgeon and Physiotherapist to achieve maximum healing and function which may take days to months. Compliance to treatment plan (keeping appointments, taking diet and medications, changing dressing, use of splints and physiotherapy) plays important role.

Duration for which part can be preserved for replantation depends upon level of amputation. Amputated part should be washed with water, wrapped in saline soaked gauge, put in a clean polythene bag and placed in another polythene bag containing ice. Immediately, after the part has been disconnected from the body, when preserved as mentioned, fingers can be replanted upto maximum of 24 hours (if microscope facility is available) and arms can be replanted upto maximum of 6 to 8 hours. In major amputation, replantation beyond 6 hours can even be life threatening. Final decision is taken by experienced Plastic surgeon on an individual case basis.

Depending upon extent of injury and patient profile, regional or general anaesthesia can be given.

There is always a possibility of failure of replant either immediately or first few days following surgery. This is due blockage in the blood vessels which are repaired. In such a case, if another attempt to repair the vessel after clearing the block fails, the part may need to be removed and wound simply closed. Chances of replant failure are more when parts are crushed and pulled out.Sometimes, life threatening sudden kidney failure or multiorgan dysfunction can occur. In such situation part may have to be removed as a life saving measure.

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