Hand surgery

Restore form and function

Dr Rajapakse is very experienced in performing a variety of hand surgical procedures.

The aims of hand surgery are to restore the functionality of the fingers, hand and wrist that can be the result of traumatic injury and infection, degenerative condition or birth defect. With all the intricate detail of the hand, it is vital that surgery is performed by trained and certified plastic and reconstructive surgeons.

Emergency Hand Surgery

Conditions that may require emergency hand surgery include:

• Fractures
• Tendon injuries
• Nerve or artery injuries
• Finger tip injuries

Common procedures used for the treatment of these conditions and injuries include:

• Fracture reduction and fixation: The fractured bones are realigned with the help of screws, plates, wires, splints and casts. It is used for fractures with completely displaced and/or crushed bones
• Skin grafts: This involves the harvest of healthy skin from an area of the patient’s body to cover or resurface the injured area. This type of operation is most commonly used for skin loss from trauma and burn reconstruction.
• Tendon repair: This is used for the management of cut tendons caused by trauma or sports injury by special sutures. Ideally the surgery is performed within 24 hours of the injury, as early surgery is associated with better outcomes.
• Nerve repair: This is a complex surgery done immediately after a nerve injury. Damage to any of the main nerves of the hand may lead to limited function and deformity. It may also result in permanent disability.
• Joint replacement: This involves the replacement of the joints in the fingers and the wrist with a new joint made of silicone rubber, a portion of the patient’s tendon or a plastic or metal implant. This is usually done in patients with osteoarthritis or traumatic arthritis of the hand to relieve pain and restore function in the affected hand.

Elective Hand Surgery

Conditions for which elective hand surgery is done include:

Dupuytren’s contractures

Dupuytren’s contracture is a disease that causes the shortening and thickening of a web of connective tissue called palmar fascia that extends across the palm of the hand to the fingers. As the disease progresses it causes the fingers to be pulled in towards the palm and become clawed and create a contracture.

Most commonly the ring finger and the little finger that are affected, but sometimes any or all fingers may be impaired.

The exact cause of the condition is unknown but the incidence of the disease is generally more prevalent in people with diabetes, older men, people who abuse alcohol and people who are taking anti-epileptic medication. It can also run in families particularly those of Celtic and Northern European ancestry.

The symptoms include nodules that can appear on the palm of the hand and a thickened cord of tissue that runs along the palm to the fingers. Over time the fingers constrict into claws.

Corticosteroid injections can be administered in the early stages of Dupuytren’s Contracture but when the hands are no longer functional surgery is usually the best option to alleviate the condition.

There are a number of surgery options and Dr Rajapakse will discuss these you  prior to any surgery taking place..

Compression syndromes

eg. carpal tunnel syndrome, cubital tunnel syndrome, distal ulnar tunnel syndrome and pronator syndrome

Carpal tunnel syndrome

The symptoms of Carpal Tunnel Syndrome can usually start slowly with a tingling, itching and burning sensation in the palm of the hand and fingers, particularly the thumb, index finger and middle finger.  The cause of this disorder is due to compression oth the median nerve which runs down the fore arm into the hand. The median nerve controls sensation to the palm side of the thumb and fingers but not the little finger. It also controls some muscles in the hand which are responsible for movement to the fingers and thumb. The carpal tunnel is a collection of ligaments and bones that form a ‘tunnel’ at the base of the hand. This ‘tunnel’ is where the median nerve and tendons are situated.

Ganglion cysts

Congenital deformities

such as fused digits, extra digits and missing digits

Tendinitis

An inflammation of the tendons, including De Quervain’s tendinitis of the thumb, flexor and extensor tendonitis of the wrist

Tumours

Removal of tumors of the skin, soft tissue or bone

Trigger finger

Locking of the finger or thumb, causing pain and impaired function.

Burn reconstruction

Hand burn reconstruction involves a combination of skin grafting and contracture release procedures to optimize appearance and function.