HAND SURGERY DIAGNOSIS AFTERCARE

There are a number of different procedures that may be involved in hand surgery, with a few general principles that are applicable to all cases: operative planning; preparing and draping the patient; hair removal; tourniquet  usage; the use of special surgical instruments; magnification (special visualization attachments); and postoperative care.

The operative preplanning stage is vitally important since it allows for the best operative technique. The hand to be operated on is shaved and washed with an antiseptic for five minutes. A tourniquet will be placed on the patient’s arm to minimize blood loss; special inflation cuffs are available for this purpose. The four basic instruments used in hand surgery include a knife, small forceps, dissecting scissors, and mosquito hemostats.

A standard drill with small steel points is used to drill holes in bone during reconstructive bone surgery. Additionally, visualization of small anatomical structures is essential during hand surgery. Frequently, the hand surgeon may use wire loupes (a special instrument held in place on top of the surgeon’s head) or a double-headed binocular microscope in order to see the tendons, blood vessels, muscles, and other structures in the hand. In most cases, the anesthesiologist will administer a regional nerve block to keep the patient comfortable during the procedure. The patient is usually positioned lying on the back with the affected arm extended on a hand platform. If the surgeon is performing a bone reconstruction, he or she may require such special instruments as a drill, metal plates and/or screws, and steel wires (K-wires).

Arteries and veins should be reconnected without tension. If this cannot be done the hand surgeon must take out a piece of vein from another place in the patient’s body and use it to reconstruct the vein in the hand. This process is called a venous graft. Nerves damaged as a result of traumatic finger injuries can usually be reconnected without tension, since bone reconstruction prior to nerve surgery shortens the length of the bones in the hand. The surgeon may also perform skin grafts or skin flaps. After all the bones, nerves, and blood vessels have been repaired or reconstructed, the surgeon closes the wound and covers it with a dressing.

Diagnosis/Preparation
With the exception of emergencies requiring immediate treatment, the diagnosis of hand injuries and disorders begins with a detailed history and physical examination of the patient’s hand. During the physical examination, the doctor evaluates the range of motion (ROM) in the patient’s wrist and fingers. Swollen or tender areas can be felt (palpated) by the clinician. The doctor can assess sensation in the hand by very light pinpricks with a fine sterile needle. In cases of trauma to the hand, the doctor will inspect the hand for bite marks, burns, foreign objects that may be embedded, or damage to deeper anatomical structures within the hand. The tendons will be evaluated for evidence of tearing or cutting. Broken bones or joint injuries will be tender to the touch and are easily visible on x-ray imaging.

The doctor may order special tests, including radiographicimaging (x rays), wound culture, and special diagnostic tests. X rays are the most common and most useful diagnostic tools available to the hand surgeon for evaluating traumatic injuries. Wound cultures are important for assessing injuries involving bites (human or animal) as well as wounds that have been badly contaminated by foreign matter. Such other special tests as a Doppler flowmeter examination can be used to evaluate the patterns of blood flow in the hand. Before a scheduled operation on the hand, the patient will be given standard blood tests and a physical examination to make sure that he or she does not suffer from a general medical condition that would be a contraindication to surgery.

Aftercare
Aftercare following hand surgery may include one or more of the following, depending on the specific procedure:oral painkilling medications; anti-inflammatory medications; antibiotics; splinting; traction; special dressings to reduce swelling; and heat or massage therapy. Because the hand is a very sensitive part of the body, the patient may experience severe pain for several days after surgery. The surgeon may prescribe injections of painkilling drugs to manage the patient’s discomfort. Exercise therapy is an important part of aftercare for most patients who are recovering from hand surgery.

A rehabilitation hand specialist will demonstrate exercises for the hand, instruct the patient in proper wound care, massage the hand and wrist, and perform an ongoing assessment of the patient’s recovery of strength and range of motion in the hand.