Dramatic advances have been made in recent years in treating patients with hand injuries, degenerative disorders, and birth defects of the hand. At the forefront of these advances have been plastic surgeons–specialists whose major interest is improving both function and appearance. Dr. Kreithen has undergone intensive training in hand surgery, and he treats patients with a wide range of hand problems.
This information is designed to give you a basic understanding of the most common hand problems–what they are, what can be done for them, and the results you can expect. It can’t answer all of your questions, since each problem is unique and a great deal depends on your individual circumstances.
If You’re Considering Hand Surgery
If you’re considering hand surgery, a consultation with Dr. Kreithen is a good place to start. He will examine you, discuss the possible methods of treatment for your problem, and let you know if surgery is warranted. If it is, Dr. Kreithen will discuss the procedure in detail, as well as the anesthesia and surgical techniques that will be used, possible risks and complications, the recovery and rehabilitation period, and the probable outcome in terms of function and appearance.
Since hand surgery is performed primarily to correct a physical abnormality or injury, it usually is covered by insurance. Check your policy or call your carrier to be sure.
All Surgery Carries Some Uncertainty and Risk
Thousands of successful hand operations are performed each year. While the procedures are generally safe when performed by a qualified and experienced plastic surgeon, complications can arise.
In all types of hand surgery, the possible complications include infection, poor healing, loss of feeling or motion, blood clots, and adverse reactions to the anesthesia. These complications are infrequent, however, and they can generally be treated. You can reduce your risks by choosing a qualified surgeon and by closely following his or her advice.
The most common procedures in hand surgery are those done to repair injured hands, including injuries to the tendons, nerves, blood vessels, and joints; fractured bones; and burns, cuts, and other injuries to the skin. Modern techniques have greatly improved the surgeon’s ability to restore function and appearance, even in severe injuries.
Among the techniques now used by plastic surgeons:
- Grafting – the transfer of skin, bone, nerves, or other tissue from a healthy part of the body to repair the injured part
- Flap surgery – moving the skin along with its underlying fat, blood vessels, and muscle from a healthy part of the body to the injured site.
In many cases, surgery can restore a significant degree of feeling and function to injured hands. However, recovery may take months, and a period of hand therapy will most often be needed (see Recovery and Rehabilitation, below).
Carpal tunnel Syndrome
The carpal tunnel is a passageway through the wrist carrying tendons and one of the hand’s major nerves. Pressure may build up within the tunnel because of disease (such as rheumatoid arthritis), injury, fluid retention during pregnancy, overuse, or repetitive motions. The resulting pressure on the nerve within the tunnel causes a tingling sensation in the hand, often accompanied by numbness, aching, and impaired hand function. This is known as carpal tunnel syndrome and can be further diagnosed with electric conduction studies.
In some cases, splinting of the hand and anti-inflammatory medications will relieve the problem. If this doesn’t work, however, surgery may be required.
In the operation, Dr. Kreithen makes an incision from the middle of the palm to the wrist. He will then cut the tissue that’s pressing on the nerve in order to release the pressure. A large dressing and splint are used after surgery to restrict motion and promote healing. The scar will gradually fade and become barely visible.
The results of the surgery will depend in part on how long the condition has existed and how much damage has been done to the nerve. For that reason, it’s a good idea to see Dr. Kreithen early if you think you may have carpal tunnel syndrome.
Dupuytren’s contracture is a disorder of the skin and underlying tissue on the palm side of the hand. Thick, scar-like tissue forms under the skin of the palm and may extend into the fingers, pulling them toward the palm and restricting motion. The condition usually develops in mid-life and has no known cause (though it has a tendency to run in families).
Surgery is the only treatment for Dupuytren’s contracture. Dr. Kreithen will cut and separate the bands of thickened tissue, freeing the tendons and allowing better finger movement. The operation must be done very precisely, since the nerves that supply the hand and fingers are often tightly bound up in the abnormal tissue. In some cases, skin grafts are also needed to replace tightened and puckered skin.
The results of the surgery will depend on the severity of the condition. You can usually expect significant improvement in function, particularly after physical therapy (see Recovery and Rehabilitation) and a thin, fairly inconspicuous scar.
Trigger finger is a disorder of the tissue around the tendon sheath of the fingers. When the finger bends, the tendon gets stuck, and manual force may be required to release the finger.
In mild cases, no treatment is needed. However as the condition worsens, a steroid injection may be required. Severe cases may lead to surgery.
The surgery for trigger finger involves a small incision to release the constricting band. Results are immediate, and recovery time is rapid, usually one to two weeks.
Recovery and Rehabilitation
Since the hand is a very sensitive part of the body, you may have mild to severe pain following surgery. Dr. Kreithen can prescribe injections or oral medication to make you more comfortable. How long your hand must remain immobilized and how quickly you resume your normal activities depends on the type and extent of surgery and on how fast you heal.
To enhance your recovery and give you the fullest possible use of your hand, Dr. Kreithen may recommend a course of rehabilitation (physical and occupational therapy) under the direction of a trained hand therapist. Your therapy may include hand exercises, heat and massage therapy, electrical nerve stimulation, splinting, traction, and special wrappings to control swelling. Keep in mind that surgery is just the foundation for recovery. It’s crucial that you follow the therapist’s instructions and complete the entire course of therapy if you want to regain the maximum use of your hand.
Dr. Joshua Kreithen is one of the most accomplished plastic surgeons Sarasota is home to. In addition to performing a range of post-bariatric cosmetic surgery procedures (such as body lift and tummy tuck), he also specializes in hand surgery. Furthermore, Dr. Kreithen offers a range of cosmetic body contouring procedures, including breast augmentation and liposuction in Sarasota / Bradenton. Please explore the respective pages to learn more about these procedures.