Traumatic Hand Injury Reconstruction

When you sustain a significant injury to your hand, it can create difficulty for you when going about your daily life or completing routine tasks. And, in many cases, it can be a detriment to professional success. The good news is that these traumatic injuries can often be addressed through reconstructive hand surgery. Thrive Reconstructive Surgery has a proven track record of success in this field. We invite you to learn more about the work done by our reconstructive surgeons.

Specializing in Hand Surgery

Hand surgery tends to be highly delicate by its very nature and requires the expertise of the most committed and detail-oriented surgeons. At Thrive Reconstructive Surgery, we have proven ourselves up to the task time and time again. Our surgeons are known for the amazing results they deliver to patients who have sustained traumatic hand injuries.

Traumatic injuries to the hand, wrist, and forearm may lead to significant limitations in an individual’s daily living and professional career. Crush injuries along with fractures, tendon or nerve damage, lacerations, and significant soft tissue defects often lead to the need for advanced reconstruction and repair to ensure the sensation and function of the hand remains intact. The field of plastic surgery has developed several innovative and complex approaches to dealing with hand salvage and repair, some of which are discussed below.

Hand Lacerations

Severe lacerations to the hand, especially those that involve extensive soft tissue injury with damage to tendons or nerves as discussed below, may require surgical intervention. However, even minor lacerations to the hand can lead to significant scar tissue and possible infection if proper closure is not performed. The role of a plastic surgeon in hand laceration repair is to explore the wound for removal of damaged tissue and of any foreign material that may cause infection. The goals of repair include extensive cleaning of the wound, achieving hemostasis, or the stop of bleeding, and closure with good cosmetic results and no postoperative infection.

Tendon Damage

Tendon damage – the need for tendon repair is the most common traumatic hand or finger injury requiring surgery to the hand. Usually following a laceration of some type to the hand, the retracted tendon is located by the plastic surgeon and reconnected to the original site in which it was cut or ruptured. Tendon repairs may either be a primary, direct surgical correction as discussed above, or secondary, which involves using a graft from another tendon in the body to repair the ruptured or lacerated tendon. Patients who undergo tendon repair surgery will be placed in a splint post-operatively to ensure the tendon heals properly to restore the full function of the hand.

Nerve Damage

Injuries to the nerves of the hand, including branches of the ulnar, radial, and medial nerves, can be detrimental to a patient, as proper sensation to the hand is vital for completing daily living and professional activities. Surgical correction to injured or lacerated nerves includes removal of damaged tissue from the nerve endings. The plastic surgeon will often use a surgical microscope to ensure adequate visualization of nerve fibers, also known as fascicles. If the remaining length of the nerve allows, fascicles are carefully re-aligned and re-attached by the surgeon to ensure sensation and motion is restored with growth of new fibers. If there is not enough healthy nerve tissue remaining after debridement, a nerve graft will be taken from another non-essential part of the body to be used in the hand. The process of nerve regeneration and return of function after surgical repair may take several weeks or months.

Hand Fractures

Fractures, also known as breaks, to the bones of the hand, most frequently including the phalanges and metacarpal bones, are common traumatic hand injuries requiring surgical intervention. Irreducible fractures or open fractures of the hand often require a technique known as open reduction and internal fixation (ORIF) in the operating room. In open fracture injuries, the plastic surgeon will extensively clean the wound and remove any damaged tissue. Fractures are stabilized using internal fixation devices known as “k-wires” to hold the bones in the appropriate place for healing and restoration of function. In the case of very complex fractures with multiple bone fragments, also known as comminuted, the surgeon will often use an external fixation device, such as a plate across the fracture line to hold fragments in place. Radiographs are always obtained at the time of fixation to ensure proper placement of devices.

Crush Injuries

Fractures, also known as breaks, to the bones of the hand, most frequently including the phalanges and metacarpal bones, are common traumatic hand injuries requiring surgical intervention. Irreducible fractures or open fractures of the hand often require a technique known as open reduction and internal fixation (ORIF) in the operating room. In open fracture injuries, the plastic surgeon will extensively clean the wound and remove any damaged tissue. Fractures are stabilized using internal fixation devices known as “k-wires” to hold the bones in the appropriate place for healing and restoration of function. In the case of very complex fractures with multiple bone fragments, also known as comminuted, the surgeon will often use an external fixation device, such as a plate across the fracture line to hold fragments in place. Radiographs are always obtained at the time of fixation to ensure proper placement of devices.

Amputations

Some severe injuries to the hand or finger, such as traumatic crush injuries, ischemia (or lack of blood flow to the area), chronic or necrotizing infection (resulting in death of the tissue), and or malignancy may require the need for amputation. The plastic surgeon is trained in various amputation techniques of the hand and fingers, including transphalangeal (through the phalange bone), finger disarticulation (through the joint space), transmetacarpal (through the metacarpal bone), or wrist disarticulation (through the wrist joint). In some cases, if not enough tissue exists around the amputation site for appropriate closure, a flap or graft can be taken from another part of the hand or finger to help cover the exposed area and bone.

Microsurgery

Traumatic injury to the hand may result in damage to the tiny nerves and blood vessels, requiring surgical intervention with an operative microscope to repair these delicate structures. This technique is known as microsurgery, in which the plastic surgeon uses magnified images to carefully re-align and re-connect important structures.

The Importance of Hand Therapy

The course of treatment for your hand depends on the extent of the injury and how fast you heal. In most cases, hand therapy under the direction of a certified hand therapist will be required in order to optimize function of your hand. Your therapy will include the fabrication of a splint to immobilize the hand after surgery, and then after the immobilization period, you will be prescribed a course of treatment. The surgery performed is the foundation for recovery. It is imperative to see the therapy regimen all the way through in order to regain maximum function of your hand.

Contact our offices to learn more about what Thrive Reconstructive Surgery can do for your hands.