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Hand Surgery

Quite possibly the most powerful natural tool, the human hand fulfills endless functions. The ability, for example, to manipulate our hands for grasping, pinching, waving, touching, shaking, or performing many other functions is essential and when injury or illness diminish this ability, it can be very devastating. Specialized attention is required to treat or repair the hand in order to improve or restore function.

What is hand surgery?

Hand surgery is plastic surgery that is performed to improve the function, physical condition, or physical appearance of the hand.

Carpal tunnel syndrome is a condition that is caused by pressure to the median nerve within the wrist, or carpal tunnel. The condition results in a tingling sensation, numbness of the fingers, weakness or aching and it can impair hand function. Carpal tunnel syndrome is associated with multiple conditions including repetitive motion, fluid retention during pregnancy, injury to the nerve in the carpal tunnel, or rheumatoid arthritis.

Rheumatoid arthritis is a disabling disease that can cause severe inflammation in any joint of the body. In the hand, it can deform fingers and impair movement.

Dupuytren's contracture is another hand disorder in which thick, scar like tissue bands form within the palm and may extend into the fingers. It can cause restricted movement, bending the fingers into an abnormal position.

Among deformities present at birth are polydactyly, defined as the presence of extra fingers, and syndactyly, where fingers are fused together. Missing fingers or a missing thumb are also congenital hand deformities.

Trauma is varied in type and severity. A hand injury that appears to be a simple cut or burn can greatly impair function when it involves the very intricate tendon and nerve system of the hand. Severed fingers or hands are extreme cases of hand trauma and in some cases, can be reattached and made functional through hand and microsurgery.

The specific condition that impairs the function or physical form of your hand is a primary factor in determining the hand surgery techniques necessary for improvement.

Where do I begin?

A consultation with Dr. Daniel Golshani is the first step to hand surgery. Dr. Golshani's consultations are designed to fully educate potential patients. Consultations typically include:

  • Options in treating the condition impairing the function or physical form of your hand
  • The prescribed course of treatment Dr. Golshani recommends
  • Likely outcomes of hand surgery and any risks or potential complications
  • A discussion of your goals for improvement

My hand surgery

Dr. Golshani may recommend your hand surgery include one, or a combination of techniques, to achieve your goals.

Microsurgery is a highly specialized technique that serves to repair or reconnect severed nerves and tendons, common in trauma cases. The most complex of all microsurgical procedures is reattachment of severed fingers or limbs.

Grafting of skin, bone, nerves, or other tissue from healthy parts of the body is used in conjunction with microsurgery in cases where hand surgery will replace an absent finger or one lost due to injury. Grafting, for example, may be used to restore a deformed finger.

Z-Plasty is an advanced incision technique that creates small triangular flaps of tissue that are transposed to close wounds over areas of the hand where flexion is essential to function, such as around knuckles. This technique is often used with burns, for example.

Skin Grafts are often used where insufficient healthy tissue exists surrounding a wound or incision for proper closure, such as a severe burn.

Preparing for surgery

Daniel Golshani, M.D., F.A.C.S. will carefully explain the hand surgery procedure you will undergo. Prior to your procedure, you will be given specific instructions regarding diagnostic testing, day of surgery procedures, postoperative care, and follow-up information. In addition, you will be asked to sign consent forms to assure Dr. Golshani that you fully understand the procedure that you will undergo and any potential risks or complications related to your procedure.

Following surgery

Bandages or dressings will be applied following hand surgery, and where indicated, splints may also be used. Before being released, you or an accompanying family member, friend or caregiver will be given specific instructions that may include how to care for the surgical site, medications to apply or take orally to aid healing, specific concerns about the surgical site, when to follow up with Dr. Golshani, and referral to a hand therapist.

Progress and Healing

The initial healing phase following hand surgery depends on your condition. Local anesthetic agents placed around the surgical site may decrease discomfort following surgery. Localized swelling and discomfort at the incision site is quite common. Depending on the procedure performed, you may be able to return to light normal activity (e.g., driving) within a few days.

Surface wound closure may take 7 to 21 days, at which time you will follow up with Dr. Golshani and have any sutures removed. Healing of nerves, tendons, and soft tissue will continue for several weeks or longer. You should continue with your hand therapy regimen and attend all follow up visits with Dr. Golshani as this is essential to a successful outcome.

Results and Outlook

The outcome of hand surgery will develop over time. In cases of carpal tunnel, modifying work habits as recommended is vital to long-term improvement. Your final outcome may not be realized for several months. In cases involving microsurgery, a year is considered appropriate to fully reach restored function.

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