The highly mobile, functional, and strong hand is a major distinguishing point between humans and non-human primates. The hand plays a very indispensable role in almost every walk of life and serves not only mechanical and prehensile functions but is also a very important organ of expression. This, unfortunately, exposes the hand to a very high risk of injury and it is no surprise that the hand is indeed the most common part of the body to be affected by trauma.
Care of the human hand needs to take into account not only recreation of form but more importantly restoration of function. It behooves the surgeon entrusted with the care of hand to be comfortable with surgery of the integumentary, musculoskeletal, nervous, and vascular tissues alike. The underlying goal of all aspects of hand surgery is to maximize mobility, sensibility, stability, and strength while minimizing pain.
AS for any surgery on the hand, it is imperative to have adequate exposure and lighting. The wound is washed and debrided thoroughly and the tendon ends retrieved. Sometimes it may necessary to extend the incision proximally and distally to facilitate repair. The cut ends may be repaired by various methods depending on surgeons preference, the most common method of a repair being Modified Kessler’s Repair, while others include Bunnels repair, Tsuge’s repair, multi-strand repair, etc.
Sometimes it may not be possible to suture the cut ends of a tendon, especially with severe crush injuries wherein a segment of the tendon is crushed and there is loss of length. These require inter-bridging tendon graft. Usual donor tendons are the palmaris longus tendon, FDS tendon of an adjacent finger or (the same finger to repair FDP), extensor indices proprius (accessory extensor for index) for extensor tendon grafts.
Running a holiday sale or weekly special? Definitely promote it here to get customers excited about getting a sweet deal.
The hand consists of 27 bones- 8 carpal bones, 5 metacarpal bones, and 14 bones in fingers. Meticulous realignment of the bones is optimal for restoration of hand function. Several muscles and tendons are attached to each small bone of the hand and the different tendon and muscle interplay also influence the healing and functioning of the joints.
Treatment includes non-surgical with splinting or casting the hand or fingers after reducing the fractures or with fixation using small pins, screws, or K-wires.
One of the most common injuries that occur daily. The fingertip is important as a tactile and sensory organ. The fingertip injuries may be classified depending upon the mechanism of injury. The nail bed complex is a specialized structure vital for the protection of the fingertip. Reconstructing the nail complex and fingertip is vital for the preservation of tactile and sensory function.
Each finger is supplied by two digital nerves running along the lateral side of their length. They in turn arise from a common digital nerve branching from median nerve to medial 3 ½ digits and from ulnar nerve to lateral 1 ½ digit. The nail bed complex is supplied by the volar nerves. This digital nerve when cut needs coaptation to prevent ulceration and further fingertip injuries due to insensate fingertips. Most repairs require either loupe or microscopic magnification and need microsurgical expertise.
Most crush injuries to the hand happen from the work site using heavy machine involve reconstruction of more than one structure. The tendons and neurovascular bundles need soft tissue cover to prevent infection and further injury.