HAND SURGERY / REPLANTATION

HAND SURGERY

In nonsurgical treatment for acute undisplaced or minimally displaced scaphoid waist fractures, immobilization of both wrist and thumb can be an option. However, in vivo scaphoid motion during forearm and thumb motion with the wrist immobilized in a cast has not been measured. Therefore, we examined the in vivo kinematics of the scaphoid during forearm and thumb motion with cast immobilization.
Replantation :Amputation injuries are devasting injuries where parts of the limbs are severed, either completely or incompletely. Amputations can involve the whole limb (termed major amputations) or just the fingers (termed digital or minor amputations).Replantation has been defined by the American Society for Surgery of the Handas "the surgical reattachment of a body part, most commonly a finger, hand or arm, that has been completely cut from a person's body."

DESCRIPTION

Replantation is the surgical reattachment of a finger, hand or arm that has been completely cut from a person’s body (Figure 1). The goal of this surgery is to give the patient back as much use of the injured area as possible. This procedure is recommended if the replanted part is expected to function without pain. In some cases, a replant is not possible because the part is too damaged. If the lost part cannot or should not be reattached, your surgeon may offer to clean, smooth and cover the cut end. This is called a completion or revision amputation. In some cases, this option will give you a better and faster recovery than a replant
Common Hand Surgery: Common reconstructive surgeries at PearlHealth address issues of hand deformities due to rheumatoid arthritis. Several surgical procedures have been perfected to return functionality to the hand, extensive rehabilitation is key to get full functioning. Plates and wires are used to correct the deformities such as boutonniere or swan neck deformities, that make the fingers bend at acute angles, as a result of arthritic impact or ageing. For the cases of Swan neck deformities, tendon grafts are placed surgically and they restore lost functions to the fingers. At PearlHealth, the plastic surgeons initially assess the extent of deformities and study the various scopes of surgery possible. In this effect they may take several X Rays to ascertain the best approach for surgery. Tissue grafting is also done entirely in house and harvesting of tissues for grafts are done with the utmost precision. Usually reconstructive surgery for the hand are straightforward and there is no limitation on mobility during the rehabilitation process. The maintaining of the support bandages for the hand is possible by repeat follow up consultations, and extreme care is afforded in order to avoid infections, pre or post operative. .

PROCEDURE

There are a number of steps in the replantation process. • Step 1: Damaged tissue is carefully removed.
• Step 2: Bone ends are shortened and rejoined with pins, wires, or plates and screws. This holds the part in place to allow the rest of the tissues to be restored.
• Step 3: Muscles, tendons, arteries, nerves and veins are then repaired. Sometimes grafts or artificial spacers of bone, skin, tendons and blood vessels may be needed, too. The grafts can be from your own body or from a tissue bank. .

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RECOVERY

Patients have a very important role in the recovery process. Generally, patients should: • Avoid smoking, as it may cause loss of blood flow to the replanted part.
• Keep the replanted part above heart level to increase circulation. Other factors that may affect recovery are:
• Age. Younger patients have a better chance of their nerves growing back. They may regain more feeling and movement in the replanted part.
• Area of injury. Generally, more use will return to the replanted part if it is further down the arm.
• Joint vs. non-joint injury. More movement will return for patients who have not injured a joint.
• Severed vs. crushed body part. A cleanly severed part usually regains better function after replantation than one that has been pulled off or crushed.
Weather Cold weather may be uncomfortable during recovery, regardless of how well your recovery is going. Use of the replanted part depends partially on re-growth of two types of nerves: sensory nerves that let you feel and motor nerves that tell your muscles to move. Nerves grow about an inch per month. The number of inches from the injury to the tip of a finger gives the minimum number of months after which the patient may be able to feel something with that fingertip. The replanted part never regains 100% of its original use, and most doctors consider 60% to 80% of its original use an excellent result. .

Hand surgery

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) including injury and infection. Hand surgery may be practiced by graduates of general surgery, orthopedic surgery and plastic surgery.[1] More formally, chiroplasty, or cheiroplasty, is a term which refers to plastic surgery of the hands. The term combines root word "chir(o)", which means "hand", and the suffix "-plasty", which means "surgical repair". Plastic surgeons and orthopedic surgeons receive significant training in hand surgery during their residency training, with some graduates going on to do an additional one-year hand fellowship. Board certified general, plastic, or orthopedics surgeons who have completed approved fellowship training in hand surgery and have met a number of other practice requirements are qualified to take the "Certificate of Added Qualifications in Surgery of the Hand" examination, formerly known as the CAQSH, it is now known as the SOTH." Regardless of their original field of training, once candidates have completed an approved fellowship in hand surgery, all hand surgeons have received training in treating all injuries both to the bones and soft tissues of the hand and upper extremity. Among those without additional hand training, Plastic surgeons have usually received training to handle traumatic hand and digit amputations that require a "replant" operation. Orthopedic surgeons are trained to reconstruct all aspects to salvage the appendage: tendons, muscle, bone. Orthopedic surgeons are trained to handle complex fractures of the hand and injuries to the carpal bones that alter the mechanics of the wrist.
The following conditions can be indications for hand surgery: • Hand injuries,Carpal tunnel syndrome,Carpometacarpal bossing,Rheumatoid arthritis,Dupuytren's contracture,Congenital defects .