Greater Washington Plastic Surgery Associates | Vineet Mehan, MD, | Earl M. Johnson, Jr., MD,

Hand Surgery in Washington DC & Fairfax, VA

hand surgery fairfax, falls church & washington, dc

WHAT IS THE HAND SURGERY PROCEDURE?

There are many types of procedures that may be required for hand reconstruction. The hand is a very specialized structure with very specialized function. A patient may need procedures on their bones for fractures. This maybe placing pins or wires or even plates and screws.

Tendons may need to be reconstructed or repaired. Nerves and arteries can also be damaged and need reconstruction or repair. All of these structures must be accurately repaired to maintain good hand function.

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What types of hand reconstruction are offered?

The most common procedures done for hand reconstruction are repair of:

Fingertip Injuries
  • Injuries to the fingertips are common in accidents at home, work, and play. They can occur when a fingertip gets slammed in a car door, while chopping vegetables, or even when clearing debris from a lawnmower or snowblower.
  • Fingertip injuries can be crushing, tearing, or amputating injuries to the tips of fingers and thumbs. Injury can include damage to skin and soft tissue, bone (distal phalanx), or to the nail and nailbed. The tips of longer fingers tend to be injured more often because they are last to escape from harm’s way.
  • Fingertips are rich with nerves and are extremely sensitive. Without prompt and proper care, a fingertip injury can disrupt the complex function of the hand, possibly resulting in permanent deformity and disability.
  • The goal of treatment is to have a pain-free fingertip that is covered by healthy skin. Your hand should be able to feel, pinch, and grip, and you should be able to perform normal hand functions. Your doctor will also try to preserve the length and appearance of your finger.
  • Specific treatment of a fingertip injury/amputation depends on the angle of the cut and the extent of the injury. Preservation of length, as well as function, and appearance of the finger are the main goals.
Tendon Lacerations

Tendons are long fibrous bands that extend from the bones of the hand and fingers to the muscles in the forearm which then contract and provide for movement.

  • A tendon injury is usually caused by a penetrating injury to the hand or fingers, typically due to laceration or puncture wound, but have also been seen in blunt impact or crush injuries where no sharp cuts are identified.
  • Tendon injuries may also be seen in conjunction with other traumatic injuries such as fractures, dislocations, and crush injuries. Crush injuries specifically are frequently associated with damage to multiple structures, including the surrounding soft tissue, nerves, arteries, and bones.
Hand Fractures

A fracture is a broken bone and can range in size from being nearly imperceptible on an x-ray to be very obvious, displaced, or even shattered.

Treatment:

  • Most fractures are treated initially by setting the bone in the emergency department, then placing it into a splint to prevent additional movement which can impede healing.
  • Fractures that are displaced, unstable (will not stay in proper alignment), open (have a cut which exposed the bone to outside the skin), or involve a joint often require surgery to realign and stabilize the bone.
  • Pins, metal plates, and screws may be used to stabilize the fracture. What is used is determined by a variety of factors, including the patient’s age, other medical problems, and the exact type of injury.
  • Hand Occupational Therapy is often used to improve range of motion, strength, and overall function after a fracture.
Nerve Injury

Nerves are the wiring system that carries messages from the brain to the rest of the body. An outer layer of tissue, called the sheath or epineurium, forms a cover to protect the nerve itself, which contains millions of individuals fibers grouped in bundles within the sheath.

Repair & Recovery

  • To fix a cut nerve, the insulation around both ends of the nerve is sewn together using microsurgical techniques
    • A nerve in a finger is only 1-2 mm thick, thinner than a piece of thin spaghetti, so the stitches have to be very tiny and thin.
  • The repair will need to be protected with a splint for the first 3 weeks to protect it from stretching apart since it is so delicate. At that point, the scar tissue around the repair should prevent it from breaking apart with normal movement.

HAND RECONSTRUCTION FAQS

Am I a good candidate?
Thanks to dramatic advances in microsurgery and minimally invasive surgical methods, many patients with hand injuries, degenerative disorders, and birth defects of their hands can now have these problems surgically repaired. Dr. Mehan and Dr. Johnson have extensive experience working with the unique structures of the hands. Injuries that just a decade or so ago would have required the patient to simply live with can now be repaired to return function. Whether your problem is a fracture, laceration, or injury to a tendon, nerve, or blood vessel, the team at Dominion Plastic Surgery can diagnose the problem and offer a solution that will return function.

Techniques used may involve grafting, flap surgery, even replantation or transplantation.

What is the recovery like?
Due to the number of nerves in our hands, you will have some moderate to severe pain during your recovery after surgery. We will prescribe injections or oral medications to help you manage the pain. Your recovery is unique to the type of injury, the severity of the injury, and the surgery used to repair it. Most surgeries will require some degree of hand immobilization, so you’ll have to take that into account if your work involves use of the hands for duties such as typing or otherwise using your fingers.
What are the risks with hand surgery?
All of the risks involved with any major surgery, and hand surgery is major surgery, apply here. Infection, poor incision healing, reaction to anesthesia, and the like. With hand surgery, a possibility is that full function cannot be returned due to the extent of the damage. There is also a possibility of lingering pain due to the many nerves in the hands.
Will I need physical therapy following hand surgery?
Odds are you will need some degree of physical therapy during your recovery. The goal of physical therapy will be to return range of motion to your fingers, in most cases. A trained hand therapist will direct your therapy. Therapy may include these items: heat and massage therapy, electrical nerve stimulation, splitting, hand exercises, traction, and special wrappings to control swelling.
Will I have a scar after my hand surgery?
It’s likely you will have a scar. This could be both from the original injury and from the reconstructive surgery. However, the return to full function will be well worth the scar.

For more information on hand surgery in the Washington, DC, Bethesda and Potomac, MD, Falls Church, Arlington, Fairfax, and Alexandria, VA areas, contact our office.