Surgery that treats major hand injuries should always be done by a specialist hand surgeon to not only repair the damage done but to restore function to the hand and fingers as soon as possible.

Soft tissue cover, grafts & flaps:

Skin grafts or flaps replace missing skin often associated with finger amputation or injury. During this procedure a piece of healthy skin is removed from somewhere on the body (the donor site) and used to cover the injured area.

Compartment Syndrome:

This is a sudden painful condition which is usually the result of blunt trauma or a bleed into a muscle compartment. It can also be associated with a fracture. A fasciotomy is an emergency procedure used to treat compartment syndrome by releasing the increased pressure within the compartment, thereby restoring blood flow to the ischaemic muscles. Untreated this pressure can cause severe pain, muscle death and destroy function.

Finger tip & nail Injuries:

The finger tips have been described as “second eyes”. Incredibly sensate, the finger tip anatomy is intricate and complex, from it’s specialised skin to the nerve endings, pressure sensors and the relationship to the nail. Plastic Surgeons are specialists in helping with disorders and injuries of the fingers.

Fractures & dislocations:

South Africans love the outdoors and sport but this comes with its share of injuries. In particular fractures and dislocations to the hands and upper limbs. It is preferable that a hand surgeon relocate any dislocations. Self relocation of a dislocation can cause a fracture and further injure a torn ligament. An x-ray is always required before treatment.

Fractures can occasionally be treated conservatively but some may require manipulation and fixation. Your plastic surgeon is likely to refer you to a hand therapist for an integral and necessary part of your treatment.

Tendon injuries & transfers:

Tendon injury can be the result of infection, trauma or rupture due to arthritic conditions. Primary repair is done within 24 hours of sudden injury and delayed primary repair is done a few days after injury. Secondary repair is done 2 – 5 weeks from injury and may include a tendon graft. This is when a tendon is removed from another part of the body and inserted in place of the damaged tendon.

Nerve injuries:

Nerve repair is used when nerves have been damaged causing loss of hand function and feeling in the hand. Although some partial nerve injuries heal on their own others may require surgery. If a nerve has been severed it may be immediately reattached using microscopic techniques, or a nerve graft is performed if a gap exists.

Brachial Plexus injuries:

The Brachial Plexus is the complex of nerves exiting the spine at the neck and traveling beneath the clavicle, through the armpit and into the upper limb. These nerves supply the muscles of the upper limb and bring back sensation.

Injury can be from birth trauma (Erb’s Palsy), from penetrating injuries or traction injuries to the neck or arm. Occassionaly primary repair is  possible. Some may require nerve grafts or muscle transfers.

Amputation, replantation & prosthetics:

Replantation is done to reattach a finger or hand that has been severed from the body. The goal is to restore as much function as possible. This is a surgical emergency and your plastic surgeon will usually need 6 hours or longer in the operating room. Complex microvascular surgery is required. Depending on the mechanism of injury and a host of other factors success is varied. Your surgeon might favour amputation if your  prognosis is poor, especially if a single non-dominant digit is involved. An attempt at saving a severed thumb is usually worth while.

Thumb reconstruction:

There are various techniques used for reconstructing a thumb. This depends on the general health of the individual, the level of amputation of the thumb and the donor site concerns of the patient. The plastic surgeon might perform a politicization. This is where an index finger is moved, shortened and rotated to design a new thumb. Thumb lengthening or webspace deepening is occasionally advised if not much extra length is needed to regain opposition (the primary function of the thumb).

Microvascular reconstruction is a highly specialized plastic surgery technique whereby tissue is brought in from another part of the body. The local blood supply is joined to the new tissue under the microscope. Microvascular second toe transfer is the most commonly employed free flap technique for reconstructing a severed thumb. Sensate, similar tissue with glabrous skin and nail complex plus tendons make this the ideal thumb replacement.