If you’re considering hand surgery, a consultation with Professor Coombs is a good place to start. He will examine you, discuss the possible methods of treatment for your problem, and let you know if surgery is warranted. If it is, he will discuss the procedure in detail, including where the surgery will be performed (in the surgeon’s office, an outpatient surgery centre, or a hospital), the anaesthesia and surgical techniques that will be used, possible risks and complications, the recovery and rehabilitation period, and the probable outcome in terms of function and appearance.

Don’t hesitate to ask Professor Coombs any questions you may have during the initial consultation-including any concerns you have about the recommended treatment and the costs involved.

Thousands of successful hand operations are performed each year. While the procedures are generally safe when performed by a qualified and experienced plastic surgeon, complications can arise.

In all types of hand surgery, the possible complications include infection, poor healing, loss of feeling or motion, blood clots, and adverse reactions to the anaesthesia. These complications are infrequent, however, and they can generally be treated. You can reduce your risks by choosing a qualified surgeon and by closely following his or her advice.

The most common procedures in hand surgery are those done to repair injured hands, including injuries to the tendons, nerves, blood vessels, and joints; fractured bones; and burns, cuts, and other injuries to the skin. Modern techniques have greatly improved the surgeon’s ability to restore function and appearance, even in severe injuries.

The carpal tunnel is a passageway through the wrist carrying tendons and one of the hand’s major nerves. Pressure may build up within the tunnel because of disease (such as rheumatoid arthritis and diabetes), injury, fluid retention during pregnancy, overuse, or repetitive motions, but most commonly it just happens. The resulting pressure on the nerve within the tunnel causes a tingling sensation in the hand, often accompanied by numbness, aching, and impaired hand function. This is known as carpal tunnel syndrome.

In some cases, splinting of the hand and anti-inflammatory medications will relieve the problem. If this doesn’t work, however, surgery may be required.

Professor Coombs usually does carpal tunnel surgery with a keyhole technique. This means your recovery is faster and you are back to your normal activities usually sooner than with the older style open carpal tunnel surgery, though occasionally this technique is required. After surgery your hand is placed in a light bandage and you can use your hand within your discomfort limits.

The results of the surgery will depend in part on how long the condition has existed and how much damage has been done to the nerve. For that reason, it’s a good idea to see a doctor early if you think you may have carpal tunnel syndrome.

Rheumatoid arthritis, an inflammation of the joints, is a disabling disease that can affect the appearance and the function of the hands and other parts of the body. It often deforms finger joints and forces the fingers into a bent position that hampers movement.

Disabilities caused by rheumatoid arthritis can often be managed without surgery-for example, by wearing special splints or using hand therapy to strengthen weakened areas. For some patients, however, surgery offers the best solution. Whether or not to have surgery is a decision you should make in consultation with Professor Coombs and your rheumatologist.

Surgeons can repair or reconstruct almost any area of the hand or wrist by removing tissue from inflamed joints, repositioning tendons, or implanting artificial joints. While your hand may not regain its full use, you can generally expect a significant improvement in function and appearance. Still, it’s important to remember that surgical repair doesn’t eliminate the underlying disease. Rheumatoid arthritis can continue to cause damage to your hand, sometimes requiring further surgery, and you’ll still need to see your rheumatologist for continuing care.

Dupuytren’s contracture is a disorder of the skin and underlying tissue on the palm side of the hand. Thick, scar-like tissue forms under the skin of the palm and may extend into the fingers, pulling them toward the palm and restricting motion. The condition usually develops in mid-life and has no known cause (though it has a tendency to run in families).

Surgery is the most common treatment for Dupuytren’s contracture. Professor Coombs will cut and separate the bands of thickened tissue, freeing the joints and allowing better finger movement. The operation must be done very precisely, since the nerves that supply the hand and fingers are often tightly bound up in the abnormal tissue. In some cases, skin grafts are also needed to replace tightened and puckered skin. Newer treatments such as collagenase injections and needle releases are also offered at Southern Plastic Surgery by Professor Coombs.

The results of the surgery will depend on the severity of the condition. You can usually expect significant improvement in function, particularly after hand therapy (see Recovery and rehabilitation.), and usually a thin, fairly inconspicuous scar.

Since the hand is a very sensitive part of the body, you may have some pain following surgery. Professor Coombs uses advanced techniques to minimize discomfort in the postoperative period. You may be prescribed oral medication to make you more comfortable but the vast majority of patients only require over the counter medication. How long your hand must remain immobilized and how quickly you resume your normal activities depends on the type and extent of surgery and on how fast you heal.

To enhance your recovery and give you the fullest possible use of your hand, Professor Coombs uses expert hand therapists to assist with your rehabilitation. Your therapy may include hand exercises, heat and massage therapy, electrical nerve stimulation, splinting, traction, and special wrappings to control swelling. Keep in mind that surgery is just the foundation for recovery. It’s crucial that you follow the therapist’s instructions and complete the entire course of therapy if you want to regain the maximum use of your hand.

(This information is courtesy of the American Society of Plastic Surgeons)

Follow the following link for further information regarding postoperative care

•  Hand-Limb Surgery