A surgical field that uses reconstructive techniques to repair injuries, entrapments, and tissue loss involving the tendons, nerves, vessels, and bones of the hand.
Indication
- Tendon injuries (flexor/extensor) following hand and finger lacerations
- Peripheral nerve injuries (median, ulnar, and radial nerve lacerations)
- Nerve entrapments such as carpal tunnel and cubital tunnel syndrome
- Surgical repair of open or closed bone fractures of the fingers and hand
- Reconstruction of complex tissue loss after trauma using flaps and grafts
- Surgical correction of congenital hand anomalies (syndactyly, polydactyly)
- Tendon-sheath problems such as chronic trigger finger and De Quervain's tenosynovitis
Preparation
- Detailed hand examination with sensory, strength, and motion testing
- X-ray, and ultrasound or MRI when needed
- Nerve conduction study (EMG) when nerve involvement is suspected
- Review of any blood-thinning medications with the physician
- Fasting for the specified time before the procedure (if anesthesia is required)
How it's performed
- Local, regional (axillary block), or general anesthesia is administered
- A tourniquet provides a bloodless field for precise microscopic work
- Severed tendons or nerves are reconnected using microsurgical suturing techniques
- Fractures are stabilized with plates/screws or wires
- Tissue defects are covered with local flaps or grafts
- The procedure is completed with protective splinting or casting
Post-procedure
- Keep the hand elevated during the first week to reduce swelling
- Splint/cast protection for 2-6 weeks depending on the injury type
- Early hand therapy and exercises in suitable cases
- Sensory re-education and long-term follow-up after nerve repairs
- Regular follow-up visits to assess functional recovery
Risks
- Infection, bleeding, and impaired wound healing
- Partial failure of tendon or nerve repair
- Joint stiffness and loss of function
- Complex regional pain syndrome (rare)
- Anesthesia-related reactions
FAQ
How quickly should I have surgery after a hand laceration?
For tendon and nerve lacerations, surgical repair within the first few days is recommended. The likelihood of a good outcome is markedly higher with early intervention.
When can I start using my hand normally again?
It depends on the type of injury. After tendon repairs, protection lasts 4-6 weeks, and full functional use may take 3-6 months.
Is hand therapy mandatory?
After tendon and nerve repairs, hand therapy is the most important factor determining the outcome; regular sessions are strongly recommended.
Will there be full recovery after a nerve laceration?
Even with microscopic suturing, nerve recovery is slow (about 1 mm per month). Partial recovery is common; complete recovery may not occur in every patient.
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