Plastic Surgery Contributions to Hand Surgery

Introduction

The phrase "hand surgery" refers to a wide range of operations. Plastic surgeons perform hand surgeries to regain finger and hand function. However, hand surgeons also try to restore the hand's natural appearance. There are numerous reasons to undergo hand reconstruction surgery, including:

• Hand wounds.

• Rheumatic conditions alter joints like osteoarthritis (the wear and tear of the protective layer of the bones called cartilage) and rheumatoid arthritis (a chronic inflammatory autoimmune disease affecting multiple joints).

• Structures in the hand that are damaged.

• Debilitating changes to the hand's structures.

• Birth abnormalities or issues with the hands are known as congenital diseases of the hands.

What Are the Different Types of Hand Surgeries That Involve Plastic Surgeons?

Skin Grafts: Grafting involves removing skin from one part of the hand and replacing the injured or diseased part. This procedure requires the removal of healthy skin from one part of the body called the donor site and carefully transferred to the injured area called the recipient site. Skin grafting is commonly seen in hand burns, amputation of fingertips, or significant injury to the hand.

Flap Surgery: A flap is transferred with its blood supply intact instead of a graft, which is only the skin. More significant amounts of tissue, including muscle, can be used with a flap if necessary. Some reconstructions require a graft as well as a flap.

• Split-Thickness Flap: In a split-thickness skin graft, the doctor takes some of the donor site's dermis (middle layer of skin) and the donor site's epidermis (top layer of skin). Some dermis are left behind to aid in the healing of the donor location. This kind of transplant is typically used in locations with extensive wounds or insufficient blood supply. A split thickness transplant is typically taken from the upper arms, buttocks, thigh, or calf.

• Full-Thickness Flap: The surgeon must remove the epidermis and dermis to cover the wound. This kind of transplant is typically used to cover a modest facial deformity, a joint, a tendon, or exposed nerves. Typically, the graft is removed from where patients have extra skin, and the donor incision can be immediately stitched up. The inner arms, forearms, upper eyelids, behind and in front of the ear, above the collarbone, and the groin are typical donor locations.

Repair of Tendons: The fibers that connect muscle to bone are called tendons. Surgery to repair a tendon in the hand is challenging due to the tendon's structure. Infection, trauma, or a sudden rupture are all possible causes of tendon injury. Primary, delayed primary, and secondary tendon repairs are the three different types.

• Primary Repair: The primary repair is frequently completed within 24 hours after an acute or abrupt injury. The injury is typically treated with immediate surgery.

• Delayed Primary Repair: Repair is typically carried out a few days after the wound, but the skin still has a wound opening.

• Secondary Repair: Further repairs could take two to five weeks or longer after the injury. Tendon grafts could be one or when ligaments from other regions are used.

Fasciotomy: This condition is characterized by swelling caused due to injury. It is often associated with pain and pressure in small spaces, leading to decreased or impaired blood flow to a particular area. This procedure is usually done under general anesthesia. In this procedure, a small incision is made in the fascia to release the pressure to prevent loss of perfusion and increase the blood supply to a particular area or tissue. In hand fasciotomy, four incisions are made.

• Radial Side of Thumb - To release the thenar component.

• Dorsal Incision Over the Index Finger - Remove first and second interossei muscles.

• Dorsal Incision Over Ring Finger - To release the third and fourth interossei muscles.

• Ulnar Incision Over Little Finger - To release the hypothenar muscles.

Surgical Debridement or Drainage: Hand infections happen frequently. Rest, heat, elevation medicines, and surgery are all possible treatments for hand infections. Surgical drainage may help eliminate pus from a lesion or abscess in the hand. Debridement may be done to remove dead and infected cells from the wound.

Replacement of Joints: In severe hand arthritis, this kind of surgery, also known as arthroplasty, is performed. It entails using an artificial joint to replace a joint ruined by arthritis. Like a tendon, this prosthetic joint could be composed of silicone rubber, plastic, metal, or bodily tissue.

Reduced Sensitivity and Fixation: This treatment option may be used when a finger or other portion of the hand has a bone fracture or shattered bone. This kind of operation realigns the damaged bone and then immobilizes it to allow it to heal. Internal fixtures such as hooks, screws, splints, and molds can be used for immobilization.

Replantation

• This kind of surgery rejoins a bodily part that has been entirely severed or cut off from the body, like a finger, hand, or toe.

• It is essential to get as much function back as possible. In replantation, microsurgery is used. Intricate surgery is carried out under a microscope with tiny instruments.

• Multiple surgeries may be necessary for some difficult situations. The interval between the damage and therapy is crucial.

• The body's divided portion lacks the blood supply, oxygen, and nutrition necessary to sustain the tissue.

• There are numerous ways to estimate time without blood, and keeping track of when the injury occurred is crucial.

• Note the interval between the damage and when the divided part began to cool. This interval is called warm ischemia time.

• Recording the period from cooling to replanting is also essential. It is known as the cold ischemia period.

• These are necessary for the effectiveness of surgery and treatment choices, as these periods may impact them.

What Are the Benefits of the Surgery?

• Relief from any deformity, infection, or pain.

• Better appearance of the hands.

• Hand functions return to normal, enabling the person to carry out daily tasks.

What Are the Complications of Hand Surgery?

• Wound infection for which antibiotic treatment may be necessary.

• Prolonged discomfort near the incision sites.

• Hematoma (a buildup of blood at the surgical site that needs to be drained).

• Failure of grafts.

• Contracture of wounds.

• Scars are easily seen, such as keloid and hypertrophic scars. They are enlarged, elevated scars that develop overhealed incisions.

• Numbness around operated sites is typically temporary and will disappear over several months.

• Seroma (which is an excessive buildup of fluid beneath the skin near a surgical site).

• Allergic reactions due to general anesthesia.

• Damage to the underlying tissue.

Conclusion:

Patients must be aware of how crucial their hands are to daily life. Therefore, they must choose a plastic surgeon who will pledge to give patients with illnesses affecting the hands and extremities the best care possible. A multidisciplinary approach with sound clinical experience and medical staff with personalized assistance is needed to achieve better results.