Hand surgery

Hand surgery is a key element of Plastic surgery. The importance of our hands to master everyday life and the density of important anatomical structures make microsurgical expertise crucial in the surgical treatment of problems with our hands. The surgeon needs detailed anatomical knowledge of the structures of the hands and the ability to repair them should the be affected, be it in the reconstruction of complex hand injuries or in the treatment of soft tissue diseases as well as nerve compression syndromes.

Examples are:

Dupuytren´s disease

Originally described as “coachman´s disease “ the condition was named after a French surgeon who first described it in the 18. Century. The condition is very frequent among patients with the so-called Celtic skin type. Often misconceived as a shortening of flexor-tendons, in reality it is a contractive disease of the underlying soft-tissues. Definite causes for the disease remains unknown, but the large numbers of patients affected in Europe makes us suppose that there might be a strong hereditary factor. Initially the patient normally notes a small nodule in the palm of his hand which continues to affect the greater part of the palm and finally leads to a fixed flexion deformity of the long fingers. There are numerous concepts to treat the condition non-surgically which have got one thing in common: they don´t help. Cure is only possible by resection of the diseased tissue, the palmar aponeurosis, a so called “aponeurectomy”. Our experience shows that partial aponeurectomy, that means removal of only the diseased parts underneath the skin, leads to recurrence in a large number of cases, requiring a second operation. The second operation is normally more extensive and we therefore tend to recommend removal of the entire palmar aponeurosis in the first place. As with everything in surgery, this has to be weighed against the individual benefits for the patient and decided from case to case. We will therefore discuss nature and extent of any surgery necessary with you in detail.

Carpal tunnel syndrome

The carpal tunnel is the space where the long flexor tendons to the long fingers and to the thumb as well as one major nerve (median nerve) course into the palm of the hand. Various reasons can lead to a raise in pressure inside the canal and therefore to affection of the nerve. Whatever the cause, the symptoms are nearly always the same: pain, numbness, loss of sensitivity in the long fingers and in the worst case motoric impairment of the thumb. Surgical treatment is splitting the rigid ligament on the “roof” of the carpal canal to relive pressure. This will be sufficient in most of the cases. Very rarely, should a motor palsy of the thumb already have occurred, will a tendon transfer be required.

Trigger finger

Our flexor tendons are kept in position via fibrous bands, so called “pulleys”. The first in line of these pulleys can block the tendon from gliding through in a variety of conditions. This results in blockage of the finger in movement out of which he can sometimes only be freed manually. A small incision into the palm enables us to identify the flexor tendon and find the pulley causing your problems. The pulley is then split. The most important thing is to spare the sensitive nerve to the finger. You are encouraged to fully move your hand immediately after surgery, to prevent adhesions. There is no functional impairment resulting from splitting the pulley.

Ulnar tunnel syndrome

Another possible source of nerve compression is in the region of the elbow. A nerve crucial for function of the lower arm muscles and hand can be compressed here. The symproms can be very painful Loss of power grip can lead to professional impairment in manual workers. In contrast to the carpal tunnel syndrome, pure release of the nerve may not be enough, additionally we recommend repositioning the nerve out of its restricted position on the back of the elbow to the front of the elbow. Reconvalecence depends on how long the pressure damage has prevailed, but it some cases it might be necessary to wear a plaster of paris cast for 10 days.