Hand Surgery

Hand surgery is a broad term that incorporates a vast array of different types of surgery on the hand. 
Surgery on the hand may be done for many reasons, including, but not limited to, the following:

• Trauma to the hand
• Rheumatic changes to the structures in the hand
• Congenital (present at birth) deformities
• Infections

Many different types of surgeries can be performed on the hand, depending on the underlying cause of the problem. The following is a brief overview of some of the types of surgery that may be performed:

• Skin grafts. Skin grafts involve replacing or attaching skin to a part of the hand that has missing skin.
• Skin flaps. A skin flap is similar to a skin graft, in which a part of the skin is taken from another area. However, with a skin flap, the skin that is retrieved has its own blood supply.
• Closed reduction and fixation. This technique may be used when there is a fracture in part of the hand, including the fingers. This type of surgery attempts to realign the fractured bone and then immobilize the area during the healing phase.
• Tendon repair. Tendons are the fibers that attach muscle to bone. Tendon injuries can occur due to infection, trauma, or spontaneous rupture. Repair of a tendon may be classified as primary, delayed primary, or secondary. Primary repair of an acute injury is usually completed within 24 hours of the injury. Delayed primary repair is usually performed a few days after the injury, but while there is still an opening in the skin from the wound. Secondary repairs may occur two to five weeks or longer after the injury.
• Nerve repairs. There are three main nerves that innervate the hand, including the ulnar nerve, the median nerve, and the radial nerve. Damage to these nerves from injury may result in decreased ability to move the hand and experience feeling. Some nerve injuries may heal on their own, while others require surgery.
• Fasciotomy. This procedure is performed to help treat compartment syndromes. A compartment syndrome is a condition that arises when there is an increase in intracompartmental tissue pressure within a space in the body, usually caused by trauma, which can interfere with the circulation to the body tissues and destroy function. In the hand, a compartment syndrome may lead to severe and increasing pain, muscle weakness, and, eventually, a change in color of the fingers or nail beds. A fasciotomy will help prevent a further decrease in function and damage of the affected extremity.
• Surgical drainage and/or debridement. Surgical drainage may be used if there is an abscess in the hand to help remove the collection of pus. Debridement, or cleansing of a wound to prevent further infection and to help promote healing, may be used if the infection or wound is severe.
• Joint replacement. This type of surgery, also called arthroplasty, may be used in people with severe arthritis of the hand. This involves replacing a joint that has been destroyed by the disease process with an artificial joint.
• Replantation. This type of surgery replaces fingers or hands that have inadvertently been amputated, usually by some type of trauma.