Joint Injuries and Replacement
Joint injuries to the hand and upper extremity are very common. They often involve bones, cartilage, joint capsule, ligaments and supporting soft tissues. The goals of diagnosis and treatment are the maximum restoration of motion, stability and strength with minimum residual pain. In severe cases, artificial joint replacement is necessary, using silicone prosthetic joints.
Accidental amputation is a true medical emergency in which time is of the utmost importance. Though some dismemberments will not qualify for reattachment, any severed body part must be immediately chilled in ice water. Both patient and amputated part are transported to the hospital for diagnosis and treatment. Hand Surgery Centre specialists are both skilled and experienced in micro-surgical reattachment.
These types of lacerations are most commonly the result of home or workplace injuries. Many are relatively minor in nature. Others however, may affect underlying structures such as tendons, nerves, blood vessels, ligaments or joints. Our qualified hand surgeons carefully assess hand, wrist and forearm lacerations with a keen eye toward possible secondary injuries, to underlying structures which may call for more extensive surgical repairs.
Injuries that require amputation mostly involve fingers, thumb, hand, wrist or forearm. Depending on the severity and scope of the injury, relatively minimal reconstructive surgery may be necessary and can be quite successful in the emergency room or physician’s office. Amputations of a major nature usually require extensive treatment involving bones, joints, tendons, nerves and blood vessels. Treatment is best in a hospital operating room by one of the Hand Surgery Centre’s qualified specialists.
What is Microsurgery?
Microsurgery is a special surgical technique that is designed to treat ultra-small structures. Because the blood vessels in nerves in the wrists and hand are usually no larger than two millimeters in diameter, microsurgery is often necessary for surgical procedures in these areas. To perform microsurgery, the trained specialist uses very fine instruments, intra-operative magnification using a microscope, and precise techniques such as redirecting blood flow from one blood vessel to another. The use of microsurgical techniques continues to expand due to the massive improvement in patient outcomes, specifically when dealing with nerve and blood vessel repair.
Replantation refers to the surgical reattachment of a completely severed digit, hand, or arm.
How is Microsurgery Involved in Replantation?
The replantation procedure is greatly helped by microsurgery techniques. Replantation is the process whereby a surgeon reattaches a severed digit or hand. Replantation can also be performed for the reattachment of larger structures, including the arm, in certain circumstances. The use of microsurgery in replantation improves the possibility for adequate functional recovery through the meticulous reattachment of nerves and blood vessels that are at the core of digital circulation, tissue health, and functional movement. Even with the advanced microsurgery techniques used today, replantation relies on prompt and appropriate examination and the proper handling and preparation of the severed digit. The examination of the injury must confirm that blood supply can be re-established in order for replantation to be possible.
What are the Causes of Hand Trauma?
A traumatic hand injury can happen to anyone and for a number of different reasons. Most commonly, traumatic injury results from some type of accident. Examples include:
- Impact during sports or other recreational activities. These injuries are usually pretty minor in nature. They may include fractures but may also involve more significant injuries like crushed structures.
- Accidents around the home can lead to a number of different traumatic hand injuries. Kitchen accidents or home improvement accidents can cause lacerations, burns, or impact traumas.
- The use of various tools, whether at home or on the job, can carry the risk of impact injury from heavy machinery or heavy objects, burns from equipment that reaches extreme temperatures, lacerations, or even amputation from moving parts.
Can Traumatic Hand Injuries be Avoided?
Due to the nature of traumatic injuries, it's difficult to say that you can prevent this altogether. That said, experts recommend being extraordinarily attentive when using any type of tool or machinery, even a kitchen knife. When working with any kind of tool, it's important to use proper technique and grip. If you become tired when working with any kind of tool, take a break. Finally, wear whatever protective gear is recommended for the work that you're doing.
Can Reconstructive Surgery Prevent the Need for Amputation?
Serious upper extremity injuries may require a multidisciplinary approach. A reconstructive surgeon may be a part of a larger medical team that includes radiologists, orthopedic surgeons or general surgeons, and other specialists. The primary purpose of reconstructive surgery performed on a digit, the hand, or the arm is to restore as much function as possible after an injury, wound, or lesion has affected the area. Reconstruction may involve skin grafting to repair a burn injury, laceration, or other trauma. It may involve tissue grafting to address exposed bone or other conditions. The details of reconstruction are unique in every situation and implemented based on data collected from medical exams, diagnostic scans, and other modalities.
It's difficult to say that reconstructive surgery can prevent the need for amputation because of the fact that every circumstance is so nuanced. Situations in which this may be possible are cases of malunion or nonunion of bones after traumatic injury or limbs affected by tumors that require removal. Malunion means that two parts of a fractured bone fail to come together properly. As it sounds, nonunion describes the complete failure of a bone to fuse at all after injury. In these cases, reconstructive surgery is performed for the primary purpose of restoring proper alignment in the affected limb. When alignment is restored, the limb may regain the stability and length that are needed to avoid amputation.
When dealing with upper limb traumatic injury severe enough for amputation to be a consideration, it is important to understand that the medical team will prioritize limb salvage. Amputation is a last-resort treatment that is performed only when absolutely necessary and after much discussion and exploration of alternatives.
Will I Need Physical Therapy After My Hand Surgery?
Depending on the complexity of your injury and surgical repair, your doctor may prescribe physical therapy for you. Initially, after hand surgery, the area may be splinted or immobilized in a cast for at least a few weeks. Physical therapy or occupational therapy may begin shortly thereafter. If your doctor prescribes rehabilitation, it is important that you attend all sessions and also perform exercises as directed in between your appointments with your hand therapist. In addition to demonstrating and assigning specific exercises for you to perform, your hand therapist may also administer massage therapy, heat therapy, electrical nerve stimulation, or other modalities during your sessions.
As an alternative to physical therapy, you may benefit from occupational therapy. This will depend on your injury and surgical outcome. Occupational therapy is warranted when an injury and its repair may affect the performance of daily activities, such as performing your job, getting dressed, or other tasks. You can expect your care team to discuss your recovery and necessary rehabilitation with you during your treatment-planning process.
Will I have Scars after Hand Laceration Repair?
Severe lacerations of the hand require prompt clinical care. These cuts tend to involve deeper tissues, such as tendons, ligaments, and muscles. The repair is imperative to future hand function as well as the prevention of infection and other complications. The laceration itself will result in scarring. One of the goals of laceration repair is to minimize this. However, the primary objective may be to ensure that the muscles and other structures that are critical to functional movement are properly repaired. After your hand surgery, you'll have scars, yes. At first, the scars may look red or pink and raised. Once your incisions have healed, after a month or longer, you can talk to your doctor about beginning a scar treatment program and what that would involve. Full scar maturation takes about one year, after which point the scar is usually very light and flat.