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. Plastic surgeons undergo intensive training in hand surgery, and they (along with orthopedic surgeons and general surgeons) treat 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 plastic surgeons can do 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. Please be sure to ask your doctor if there is anything about the procedure you don’t understand.
If you’re considering hand surgery, a consultation with a plastic surgeon is a good place to start. The surgeon will examine you, discuss the possible methods of treatment for your problem, and let you know if surgery is warranted. If it is, the surgeon will discuss the procedure in detail, including where the surgery will be performed (in the surgeon’s office, an outpatient surgery center or a hospital), 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.
Don’t hesitate to ask your surgeon any questions you may have during the initial consultation, including any concerns you have about the recommended treatment and the costs involved. (Since hand surgery is performed primarily to correct physical abnormalities, it usually is covered by insurance. Check your policy or call your carrier to be sure.)
Good candidates have droopiness of the cheeks and jowls. Patients should not be too heavy or too thin, should be medically well and not be on blood-thinning medication.The best candidates have realistic expectations with the desire for a quick, risk-diminished lift effect without the scars, recovery, expense or risks of surgery associated with a more traditional facelift.
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When a facelift is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable.
Complications that can occur include hematoma (a collection of blood under the skin that must be removed by the surgeon), injury to the nerves that control facial muscles (usually temporary), infection, and reactions to the anesthesia. Poor healing of the skin is most likely to affect smokers. You can reduce your risks by closely following your surgeon’s advice both before and after surgery.
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.
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, the surgeon makes an incision from the middle of the palm to the wrist. He or she 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 a doctor 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. The surgeon 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.
In Dupuytren’s contracture, scar-like tissue in the palm pulls fingers into an abnormal position. The surgeon may make zig-zag incisions across this band of tissue, creating small skin flaps.
In Dupuytren’s contracture,
scar-like tissue in the palm
pulls fingers into an abnormal
position. The surgeon may
make zig-zag incisions across
this band of tissue, creating
small skin flaps.
After surgery the repositioned
flaps expand like an accordion,
allowing freer finger motion.
After surgery the repositioned flaps expand like an accordion, allowing freer finger motion.
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.
Since the hand is a very sensitive part of the body, you may have mild to severe pain following surgery. Your surgeon 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, your surgeon 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.
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