Plastic surgery is a very broad field that encompasses almost every part of the body. The hand has classically been a domain treated by plastic surgeons and orthopedic surgeons secondary to the intricate and complex combination of soft tissue and bone reconstruction. Treatment of injuries to the hand include management of open wounds, lacerations and amputations to the fingers, hand and upper extremity. These traumatic wounds may also involve injuries to underlying blood vessels, nerves, tendons and muscles, as well as bones. These can all be managed by a plastic surgeon with experience in hand surgery. Other common disorders of the hand include infections, inflammatory conditions, and congenital deformities.
Hand and finger injuries are some of the most common reasons to visit an emergency room and urgent care. Dr. Trussler is available to efficiently and effectively see you after your emergency room visit if needed.
What Are My Options?
Dr. Trussler provides a full spectrum of reconstructive procedures of the fingers, hand, and upper extremity, including those requiring care for:
Fractures: broken bones of the fingers and hands.
Dislocations: interruption of joint alignment.
Lacerations: sharp injury to the skin, nail bed, tendon, muscle, nerve, and blood vessels.
Amputations: sharp injury to the fingers may amputate the tip or entire finger.
Infections: puncture wounds, animal, human, snake and insect bites, open wounds, and foreign bodies.
Malignancy: skin cancer and tumors of the bone and tendon.
Burns: thermal injuries to the fingers and hand.
Inflammatory diseases: arthritic conditions, trigger fingers.
Nerve Compression: carpal tunnel.
Congenital Disorders of the Hand: children are born with extra digits
(polydactyl), webbing of the fingers and toes (syndactyl), and absence of digits.
Reconstructive hand surgery is most often performed to repair injured soft tissue and bone after trauma. These injuries may only need in-office wound care, suture placement or splinting, however more severe injuries may need an operation to repair the intricate and delicate structures in the fingers and hands.
- Small plates, screws, and pins are often used to secure fractures of the bones
- Sutures, pedicle flaps, and skin grafts may be needed to close open wounds
- Nerves and blood vessels require repair utilizing an operative microscope
- Reattachment of severed fingers and hands may require a combination of bone, and tendon repair with microscopic repair of the blood vessels and nerves.
After the repair of the injured digit, it is vital to balance healing process with early movement. This is very important to preserve function of the injured digit and will be guided by a specialized hand therapist who can help with functional splinting, wound care, range of motion and scar care.
The reconstructive goals for the hand and fingers are the repair of the injury, the removal of the lesion and closure of the open area, or the correction of the scar deformity with the maintenance or improvement of form and function.
In the reconstructive process there may be more incisions and/or donor sites created to harvest the tissue used for closure. These incisions will form scars which will heal and fade over time. Additional procedures may be needed such as scar revisions, flap division and inset, and scar care after the area of surgery is healed.
There are certain risks associated with each type of procedure, as well as general risks such as bleeding, infection, anesthesia complications, as well as permanent digital stiffness, scarring, and need for amputation. Dr. Trussler will discuss the specific risks of your hand procedure before surgery.
Reconstruction of the hand is usually an outpatient procedure performed either under local or general anesthesia. The hand is very sensitive and in order for Dr. Trussler to perform precise and complex procedures the patient needs to be comfortable. Minor hand procedures can be performed in the office under local anesthesia. Extensor tendon repair, simple wound care, small skin grafts and minor finger tip surgery can all be performed as in-office procedures. In the majority of operative hand procedures, an upper extremity tourniquet is placed to allow for a bloodless operative field. This tourniquet can be uncomfortable and deep twilight or general anesthesia is typically required.
- Fractures: broken bones of the fingers and hands can be held in place with a splint or cast. Commonly, displaced or unstable fractures need to reset in the operating room and secured with pins, plates, and/or screws. Small incisions may be made to help to reduce the fracture and allow for plate placement. Stitches in the skin are used to close the incision and the hand is placed in a cast or splint to help immobilize the injured hand.
- Dislocations: joint re-alignment may be performed in the office or for more complex dislocations, an open approach to the joint with reduction of the joint to a normal position and possible pin placement to help heal in the proper position are needed.
- Lacerations: sharp injury to the hand may involve numerous structures depending on the location and depth of the injury.
- Skin lacerations can be repaired with stable or absorbable stitches with care taken to avoid tension across joint creases
- Nail bed lacerations are common in finger tip injuries and should be repaired to encourage normal nail growth. The nail plate should be removed and the laceration repaired with fine absorbable stitches and the nail replaced to preserve the nail fold.
- Tendon lacerations include the flexor tendons in the palm of the hand and the extensor tendons on the back of the hand. Tendon lacerations should be repaired with durable sutures to preserve movement of the fingers. Extensor tendon repairs can be performed in the office because they are easily exposed. Flexor tendon repairs should be performed in the operating room to accurately repair the injury and avoid the neurovascular bundles on each side of the tendons.
- Muscle lacerations can heal on their own or with larger sutures to repair the muscle and then immobilization with a cast or splint to let the area heal.
- Nerve lacerations in the hand and fingers help to preserve sensation and movement. The nerves are small structures and should be repaired utilizing the operative microscope.
- Blood vessels in the hand and fingers are vital to the survival of the extremity. The blood vessel network is redundant, but significant injuries that affect blood flow to the extremity should be repaired. The blood vessels are small structures and should be repaired utilizing the operative microscope.
- Amputations: sharp injury to the fingers may amputate the tip or entire finger. If a segment of the finger tip is preserved on ice, it can be reattached as a composite graft with stitches. This can be performed in the office or emergency room within a 6 hour period. Complete amputation of a digit, especially a thumb can be reattached (replantation) in the operating room with the use of an operative microscope to restore blood flow to the finger and repair the bone, tendon and nerve injuries.
- Infections: puncture wounds, animal, human, snake and insect bites, open wounds, and foreign bodies can all lead to infections of the hand and fingers. Infections around the finger tip (felon) and nail (paronychia) may need drainage in the office and removal of the nail. Infections on the back of the back can usually be drained easily, but infections in the palm can travel up the arm and can fester in the closed spaces of the hand. These should be explored and drained in the operating room.
- Malignancy: skin cancer and tumors of the bone and tendon can be removed in most instances without the need for amputation. Moh’s surgery may be needed for skin cancer removal and any open wound can be covered with a skin graft or pedicle flap.
- Burns: thermal injuries to the fingers and hand are usually second degree burns which can heal with local wound care without the need for operative intervention.
- Inflammatory diseases: arthritic conditions, and trigger fingers are common with patients who use their hands significantly. Options for treatment include splinting, steroid injections and possible operative intervention to address the joint or tendon in question.
- Nerve Compression: the carpal tunnel is the most common area of nerve compression and can be released with a operation which opens the tough ligament around the median nerve at the wrist. There are multiple other areas of nerve compression in the upper extremity and a nerve conduction study should be performed before any operative intervention to locate the area(s) of compression.
- Congenital Disorders of the Hand: children are born with extra digits(polydactyl), webbing of the fingers and toes (syndactyl), and absence of digits. These birth deformities may be related to other congenital syndromes which should be addressed prior to any hand surgery, though simple webbing and/or extra digits can be treated with short operations after the first year of age.
After Care & Recovery
Recovery from hand surgery and upper extremity reconstruction depends on the type of treatment performed.
- Patients are typically immobilized in a padded plaster splint for comfort after their surgery
- Elevation with a foam support pillow (Carter Pillow) is the optimal position to encourage a smooth and comfortable recovery following any hand procedure.
- For a short time after hand surgery, patients may experience mild throbbing or a dull headache, with some swelling, bruising, and oozing around the surgical site.
- Incisions are usually closed with absorbable stitches and typically dressed with antibiotic ointment and non-adherent gauze.
- Pins may be exposed and can be kept clean with half strength peroxide and ointment.
- The hand should be kept dry until the splint is removed, though showering is possible the day after the procedure with a bag on the extremity. Once the splint is removed, the hand and incisions can be washed gently.
The operative splint is typically removed in approximately one week, and then transitioned to a custom made splint by your hand therapist. Hand therapy and early range of motion is directed by Dr. Trussler and your hand therapist, and this may start the day after surgery. Wound care, edema control and scar care can all be performed with your hand therapist.
The results of hand reconstruction become gradually apparent as the days pass after surgery and swelling recedes. Function and sensation in the hand and fingers will return over time. Home hand therapy with range of motion exercises will help with function and movement of the hand. Swelling may be persistent or reappear from time to time with over use of the hand. Elevation, anti-inflamatories, and edema control can all help with persistent swelling.
Scar care will be started at the three week point after surgery to help fade scars. Dermabrasion and laser resurfacing may be needed to help flatten the areas of reconstruction. Revision procedures and flap divisions may usually be considered at the three week to three month point after surgery, however scars will typically take about one year to fully mature and fade.
Dr. Trussler will provide patients with specific after care instructions in order to facilitate proper healing and successful return to function after your hand surgery.
*Disclaimer: Results and individual patient experience may vary.
Whether you have a question or would like to setup a hand surgery consultation, Dr. Trussler and his staff are here to help. Please fill out our contact form, or call our office at 512-450-1077 to schedule an appointment. Start your journey to not only looking, but feeling better today!