What Is Hand Surgery?
 

Hand surgery incorporates a vast array of different types of surgery on the hand. Plastic surgeons who perform hand surgery attempt to restore not only the function of the hand, but try to maximize the cosmetic appearance of the hand, as well.

Surgery on the hand may be done for many reasons, including, but not limited to, the following:
 

•     Trauma

•     Rheumatoid  and Osteoarthritis

•     Congenital deformities

•     Infections

 

What Are the Different Types of Hand Surgery?
 

There are many different types of surgeries that can be performed on the hand, depending on the underlying cause of the problem. The following is a brief overview of some of the types of surgery that may be performed:
 

Closed reduction and fixation:

This technique may be used when there is a fracture in part of the hand, including the fingers. This type of surgery attempts to realign the fractured bone and then immobilize the area during the healing phase. Immobilization can be done with internal fixtures, such as with wires, rods, splints, and casts.
 

Tendon repair:

Tendons are the fibers that attach muscle to bone. Repair of tendons remains a surgical challenge because of the structure of the tendon. Tendon injuries can occur due to infection, trauma, or spontaneous rupture. Repair of a tendon may be classified as primary, delayed primary, or secondary. Primary repair of an acute injury is usually completed within 24 hours of the injury. Delayed primary repair is usually performed a few days after the injury, but while there is still an opening in the skin from the wound. Secondary repairs may occur two to five weeks or longer after the injury. Primary repairs usually involve direct surgical correction of the injury, while secondary repairs may include tendon grafts (inserting tendons from other areas of the body in place of the damaged tendon) or other more complex procedures.
 

Nerve repairs:

There are three main nerves that innervate the hand, including the ulnar nerve, the median nerve, and the radial nerve. Damage to these nerves from injury may result in decreased ability to move the hand and experience feeling. Some nerve injuries may heal on their own, while others require surgery. Overall, about three to six weeks after the injury is the best time for nerve repairs that are associated with other, more complicated, injuries. Surgery to investigate a damaged nerve that is not complicated by other injuries is usually performed early after the trauma, to increase the likelihood of a full recovery. If severed, the nerve may be repaired by reattaching it directly to the other end of the nerve, or by using a nerve graft (inserting nerves from other areas of the body in place of the damaged nerve) to repair the damaged section.
 

Surgical drainage and/or debridement:

Our hands are constantly at risk for injury and infection. Infections of the hand are a common reason people seek treatment. The treatment for infections to the hand may include rest, use of heat, elevation, antibiotics, and surgery. Surgical drainage may be used if there is an abscess in the hand to help remove the collection of pus. Debridement, or cleansing of a wound to prevent further infection and to help promote healing, may be used if the infection or wound is severe.
 

Joint replacement:

This type of surgery, also called arthroplasty, may be used in people with severe arthritis of the hand. This involves replacing a joint that has been destroyed by the disease process with an artificial joint. This artificial joint may be made out of metal, plastic, silicone rubber, or the patient's own body tissue (such as a tendon).

 

What Can I Expect After Hand Surgery?
 

Recovery after hand surgery depends greatly on the type of surgery that was performed and the underlying cause of the hand condition. Sometimes, repeat surgeries are needed. The hand is an intricate part of our lives and is very sensitive.

Mild to severe pain may be expected after many types of hand surgeries. Pain medications may be given to help alleviate the discomfort.
 

The following are some of the other possible outcomes that you may be told to expect following hand surgery:
 

• Your hand may be immobilized in a bandage or splint after surgery. Your physician will decide the length of time of the immobilization. After some surgeries, the hand may be immobilized for months at nighttime to enhance recovery.

• There may be some restrictions placed on activities and work after the surgery. This also will be determined by your physician, based on an individual basis.

• Rehabilitation may be recommended to increase the strength and function of the hand. Rehabilitation may include physical therapy and/or occupational therapy. A trained specialist will be involved in your care to optimize recovery of the hand.
   

Therapy of the hand may include the following:
 

• Exercises for the hand

• Heat therapy

• Massage therapy

• Splinting

• Traction

• Bandages to help control swelling

• Nerve stimulation
   

In many cases, surgery is just the start of recovery. Intensive rehabilitation may be necessary to regain optimal functioning of the hand. It is important to follow all of the instructions given to you after surgery by your physician and any other specialists that are involved in your care.

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Planning for Your Procedure
 

If surgery is scheduled, you will receive specific, personalized instructions. Following these instructions as well as the basic guidelines before, during and after surgery can help ensure a smooth and successful treatment experience.
 

Before the Procedure
 

Eating before surgery
 

Remember not to eat or drink anything after midnight prior to your surgery, or as directed by your anesthesiologist. This includes water, breath mints and even chewing gum. Having food in your stomach can create a risk during surgery.
 

Medications
 

Consult your doctor about whether you should discontinue taking regularly scheduled medication, herbal products or aspirin prior to surgery. If you are advised to continue taking your medication, you should take it with only a sip of water. Do not take any aspirin or any aspirin-containing products at least seven days prior to your surgical procedure. This includes any anti-inflammatory medications. If you have any questions regarding this or any medication you are currently taking on a regular basis, please call and speak to your physician's nurse or medical practitioner.
 

Plan to arrive early for surgery
 

You must plan to arrive at the hospital at least two hours prior to your scheduled surgery time. Your surgery coordinator will call you with this time one day prior to your surgery date.
 

Arrange for a ride after surgery
 

Be sure to make arrangements in advance to have a responsible adult drive you home and be available to you after surgery. You will not be able to drive yourself home nor can you use a taxi. Please make arrangements for someone to drive you.
 

Questions about anesthesia?
 

Your anesthesiologist may call you the night before your surgery to answer any questions you have regarding anesthesia. Your surgery coordinator does not know who the anesthesiologist will be and cannot answer questions pertaining to anesthesia or anesthesia billing.
 

Other information
 

Do not sunbathe at least one week prior to surgery due to the risk of sunburn. Refrain from smoking after midnight and during the day of your surgery.

 

Day Of and During Surgery
 

Before you leave home
 

Wear loose fitting, comfortable clothing so that you can change easily after surgery. Do not wear makeup, nail polish or jewelry. Bring your health insurance card and insurance forms with you. Leave all valuable items at home. Bring any X-rays, MRI scans, lab studies, physician orders, etc. that may relate to your surgery.
 

Surgery facility
 

Our surgeons operate at three facilities: Stanford Medicine Outpatient Center in Redwood City, Ambulatory Surgery Center in Palo Alto and Stanford Hospital in Palo Alto. Your surgery scheduler will confirm the surgery location with you.
 

When you arrive
 

To ensure that there is adequate time to fill out the necessary forms and prepare for surgery, please arrive at your designated facility at least two hours before your scheduled procedure. Family members and friends are welcome to join you.
 

Upon arrival at the facility, please register at the Patient Registration Area located inside the reception area. You will then be escorted to a preparation room, where you'll be asked to change into a hospital gown. At this time, a nurse will perform a simple physical examination to check your weight, blood pressure and temperature. From the pre-operative area, you will then be taken to the operating suite for your procedure. During the time that you are in surgery, your family and friends are welcome to wait in the reception area.

 

After Surgery
 

Self-care
 

Keep your dressings clean and dry until your doctor says otherwise. If you need to bathe or shower, cover the dressings with a plastic bag taped securely at the opening to prevent getting wet, and keep the area out of the direct stream of water. If your dressing becomes wet, call your doctor immediately. DO NOT remove or modify the dressing unless instructed by your doctor.
 

Elevate your arm and hand
 

To prevent and minimize swelling and pain, raise the hand/arm above the level of the heart for 3-5 days. When indicated, you will be given a sling or blue Carter pillow. The hand may be held down only for brief periods of time. Continue to elevate the hand if swelling or pain persists after 3-5 days. Move your unaffected joints on the surgical side as much as possible to help with swelling and prevent stiffness. For example, if you had surgery on your thumb, then move your shoulder, elbow, wrist and other fingers.
 

Are you having tingling or burning in your arm or hand?
 

If you had a local or regional block anesthetic, your arm or hand may be numb for several hours or even overnight. As the numbness wears off, you may have a tingling or burning sensation which will eventually disappear. If the numbness persists after 24 hours, call your doctor. Protect your arm from potential injury, e.g., car doors, cuts, excessive heat or cold, etc. Use the sling or blue Carter pillow provided to you.
 

Take your pain medication
 

Start your prescribed pain medication as soon as you get home, DO NOT WAIT for the anesthetic to wear off. In order to minimize nausea, eat some food before taking your medication. Consult your doctor for severe pain that is not relieved by the medication and elevation. 

 

What Are the Risks of Hand Surgery?
 

Most surgery carries the risks of anesthesia and bleeding. Additional risks associated with surgery depend greatly on the type of surgery being performed and may include, but are not limited to, the following:
 

• Infection

• Incomplete healing

• Loss of feeling or movement of the hand or fingers

• Blood clots may form

• Tissue Loss​