Type of Surgery
Last updated: 11/24/2009
There are a number of different procedures that may be involved in hand surgery, with a few general principles that are applicable to all cases: operative planning; preparing and draping the patient; hair removal; tourniquet usage; the use of special...
surgical instruments; magnification (special visualization attachments); and postoperative care. The operative preplanning stage is vitally important since it allows for the best operative technique. The hand to be operated on is shaved and washed with an antiseptic for five minutes. A tourniquet will be placed on the patient's arm to minimize blood loss; special inflation cuffs are available for this purpose.
The four basic instruments used in hand surgery include a knife, small forceps, dissecting scissors, and mosquito hemostats. A standard drill with small steel points is used to drill holes in bone during reconstructive bone surgery. Additionally, visualization of small anatomical structures is essential during hand surgery. Frequently, the hand surgeon may use wire loupes (a special instrument held in place on top of the surgeon's head) or a double-headed binocular microscope in order to see the tendons, blood vessels, muscles, and other structures in the hand.
In most cases, the anesthesiologist will administer a regional nerve block to keep the patient comfortable during the procedure. The patient is usually positioned lying on the back with the affected arm extended on a hand platform. If the surgeon is performing a bone reconstruction, he or she may require such special instruments as a drill, metal plates and/or screws, and steel wires (K-wires). Arteries and veins should be reconnected without tension. If this cannot be done the hand surgeon must take out a piece of vein from another place in the patient's body and use it to reconstruct the vein in the hand. This process is called a venous graft. Nerves damaged as a result of traumatic finger injuries can usually be reconnected without tension, since bone reconstruction prior to nerve surgery shortens the length of the bones in the hand. The surgeon may also perform skin grafts or skin flaps. After all the bones, nerves, and blood vessels have been repaired or reconstructed, the surgeon closes the wound and covers it with a dressing.
There are several bones in the wrist joint and trauma to this area can cause one of a number of wrist and arm fractures. One of the most common types of wrist fracture, called a Colles fracture, is discussed as well one way to treat the fracture.
The field of hand surgery deals with both surgical and non-surgical treatment of conditions and problems that may take place in the hand or upper extremity (commonly from the tip of the hand to the shoulder). Hand surgery may be practiced by graduates of general surgery, orthopedic surgery and plastic surgery. Plastic surgeons and orthopedic surgeons receive significant training in hand surgery during their residency training, with some graduates continuing on to do an additional one year hand fellowship. These fellowships are sometimes also pursued by general surgeons. Plastic surgeons are particularly well suited to handle traumatic hand and digit amputations that require a "replant" operation. Plastic surgeons are trained to reconstruct all aspects to salvage the appendage: blood vessels, nerves, tendons, muscle, bone. Orthopedic surgeons are particularly well suited to handle complex fractures of the hand and injuries to the carpal bones that alter the mechanics of the wrist. Hand surgeons perform a wide variety of operations such as fracture repairs, nerve decompressions, releases, transfer and repairs of tendons and reconstruction of injuries, rheumatoid deformities and congenital defects.
New procedures like minimally invasive procedures are often subject to scrutiny, but I think that one of the biggest problems facing these innovative procedures is for people to understand exactly what we do.
-Dr. Michael Perry, Laser Spine institute
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