» Hand Surgery
Hand is the biggest gift to man kind, Life is
possible without eyes but not without hands. Hand is complex both in its
structure & function and for this reason all surgery on hand are
performed under bloodless field using magnification. Hand is the most
commonly involved body part in accidents both at home & at place of
work. Reconstruction of the hand defects and injuries to hand have to be of
superlative degree and are best performed by Plastic surgeons trained in
Hand surgery and microsurgery .
Birth Defects of Hand
Development of hand takes place during the 4 th to
the 8 th week of pregnancy. The abnormalities of hand are occur very often.
These are mostly genetic and have a tendency to run in families. Presence of
extra digit (Polydactyly) is genetic and it so common that in one of Arabian
tribes a child that has only ten fingers is considered evil. Removal of
extra digit should be done early in life and careful restoration of bony
contour and joints are important.
Syndactyly (Joined / webbed fingers). Commonly occurs between the middle &
ring finger separation of fingers by plastic surgery is required to prevent
abnormal development of fingers. Some times Several fingers or all the
fingers are joined together. Such conditions require to be treated very
early in life. Abnormality of the Thumb absence of thumb or duplication
Uncommon but is correctable by PlasticSurgery.
Timing and Technique :
All the defects of hand should have consultation with plastic Surgeon early
in life preferably in the first year of life. The treatment is so planned
that the child has a normal hand by the time he / she is 5 years of age.
Development of hand completes at the age of five years
All Surgical procedures over hand will have better results and less chance
of damage to other structures if performed by Microsurgery . All Hand
surgery in Max is performed by Surgeons Trained in Microsurgery
The Injured Hand :
Hand is often injured at home or at place of work.
Even a simple looking cut over the hand may have damaged important
structures in the depth.This is because of the complex nature of hand
anatomy therefore a proper examination & repair of all the divided
structures is very important for good recovery of hand function.
Injuries may be as trivial as child getting a finger in the door to complex
crushing in machinery or some times complete amputation of the hand or parts
of hand. Repair and restoration of all divided and damaged structures need
to be done care fully under magnification for best functional recovery.
Fractures of the Hand that are associated with wound needs attention of
Plastic Surgeon trained in mhand & microsurgery. The use of microsurgery
and use of muscle flaps in the early period of injury has improved recovery
and made even very severely injured limbs salvageable.
Micro vascular Surgery
One of the most charismatic advance in plastic surgery. Microvascular
surgery requires special training. This advance has made it possible to
reattach a totally amputated part from the body. The surgery is called
Replantation the replanted part will look normal and functions normally.
Some of the commonly amputated parts are Fingers, Thumb, Hand from wrist or
whole of the arm. Some times other parts of body like the, Hairs of head get
entangled in drive belts and get detached, these also can be put back by
First aid and preservation is very important for the success of such
Any part that is totally amputated from the body should be sealed in a
clean polythene bag, within 2 hours of amputation. This polythene should be
kept over ordinary ice. Once preserved in this way the patient can be
transported to the hospital. Replantation can be successfully done even upto
24 hours. We have successfully replanted more than 300 such cases and the
longest duration after which replantation has been successful was 22 hours.
Even if the amputation is not complete in sever injuries the blood supply
to the limb may be severed. Partial or completed severance of blood Supply
to a part of the body requires plastic surgeons to perform Micro vascular
Repair and thus salvage the body part. Injury to nerves or Tendons that move
the fingers gives best results when repaired under magnification.
Deformities following injuries can be minor having only Aesthetic
considerations or there may be sever impairment of hand function, some times
there are old amputations that could not be replanted leading to complete
loss of hand function.
Reconstruction of hand deformities is performed keeping hand function in
hand. It is possible to repair and reconstruct almost every component of
hand. A missing thumb in an adult folloing injury is reconstructed by
transferring the Second toe or parts of great toe to construct the thumb by
microsurgery. Thumb so reconstructed has normal function. (foot to Hand
Chronic Disease Involving Hand
Some deformities are a result of generalized disease
process like the Rheumatoid hand & Dupytrens contractures which
are a part of disease process. Various reconstructions and even replacement
of small joints of hand is performed to obtain functional recovery.