Reconstructive Hand Surgery Perth

Reconstructive hand surgery repairs hand deformities, relieves associated pain, restores function, and improves the hand's overall appearance. 

What is reconstructive hand surgery? 

Reconstructive hand surgery began shortly after the second world war when the need arose for more proactive management of traumatic hand injuries. Since then, the procedure has become more refined and widespread, with over 200,000 hand reconstructions done yearly in Australia. 

The hand is the tool of tools, a dynamic natural device that helps us communicate and express our deepest emotions. A disabling hand injury usually reduces the quality of life, reflecting how integral our hands are to our daily lives. A person may have a physical defect at birth or suffer a deforming hand injury. 

Which conditions require hand reconstruction? 

Reconstructive hand surgery can be used to treat conditions including: 

• Congenital hand malformations: Syndactyly, extra fingers or absence of some fingers can benefit from hand reconstruction shortly after birth. Reconstructive hand surgery can also correct transposed digits and abnormally small or large fingers. 
• Trauma to the hand: This includes severe physical injuries to the hand, causing tears of tendons, ligaments and muscles. Injuries that expose the soft tissues and bones of the hand may require flap repairs. Fractures of the small bones of the hand can be surgically corrected using plates, screws, and wires.
• Dupuytren contracture: Progressive thickening of the palm and underlying soft tissues causes the fingers and hand to curl inwards. The condition affects people older than 40 years, but surgical reconstruction can help slow progression and improve mobility. 
• Severe burn injury: Scars formed after severe burn injuries may cause contractures that prevent adequate hand function. You may need reconstructive surgeries to remove scar tissues, regain function and improve cosmetic appearance. 
• Carpal Tunnel Syndrome: The carpal tunnel is a small conduit at the wrist through which nine tendons and the median nerve passes. Pressure may build up in this tunnel during pregnancy or diseases like rheumatoid arthritis, compressing the median nerve. Nerve compression can manifest as tingling, numbness, aching or weakness of grip and other hand movements. A carpal tunnel surgery helps to relieve the pressure in severe cases. 

How to prepare for reconstructive hand surgery 

A hand reconstruction is a rigorous procedure that could change your life. You need to get every detail right, from the moment you decide until entering the theatre. 

• Get a qualified surgeon: You need a surgeon with the right experience and disposition. Beyond academic credentials, a top doctor will listen to you with empathy and help you identify your treatment goals. Your doctor will help you determine if you need reconstructive surgery and help prepare you mentally and medically. 
• Laboratory investigations: Surgeons need lab tests to determine your eligibility for surgery and know your pre-surgery laboratory parameters. Your doctor will request radiological investigations to assess the degree of bone and soft tissue involvement. You may also need blood investigations, an electrocardiogram and tests to evaluate liver and kidney function. 
• Avoid smoking and alcohol intake: The World Health Organization recommends that you stop smoking and alcohol intake for at least 6-8 weeks before elective surgery. Cigarette and tobacco smoke contains nicotine, hydrogen cyanide and other dangerous chemicals. These components interfere with tissue regeneration and may delay the healing of surgical wounds. Alcohol can aggravate pain from the surgery and slow down the healing process. 
• Costs: Costs vary depending on the injury severity and the complexity of the reconstructive procedure required. Health insurance coverage may cushion some financial implications. Some of the costs you need to consider include:
•    Medical facility costs 
•    Surgeon’s payment 
•    Cost of medication 
•    Cost of medical tests 
•    Cost of post-surgical care 

How is reconstructive hand surgery done?

The exact techniques used during a hand reconstruction surgery vary depending on the type of deformity and severity of the injury. 

Generally, your surgery will go through these two stages below: 

• Anaesthesia: Specialists use drugs and inhaled gases to induce loss of physical sensations, especially pain. Some anaesthetic agents put you to sleep, while others reduce muscle tone for easier manipulation of the surgical field. 
• Incision and Reconstruction: You may undergo open hand surgery or microsurgery with microscopes depending on the required corrections. Some of the reconstructive procedures include: 

? Skin grafts are pieces of healthy skin transplanted from one part of the body to another. Skin grafts lack intrinsic blood supply and are primarily used for fingertip injuries. 

? Unlike grafts, skin flaps have their own blood supply and are used to repair extensive soft tissue and blood vessel damage. 

? Nerve and tendon repairs are done by attaching the cut ends together to improve the chances of full recovery of function. 

? Arthroplasties are done to replace joints in the hand or wrist in degenerative conditions like arthritis. 

? Fasciotomy is done by cutting through muscle fascia to treat hand swellings that compromise blood supply, such as compartment syndrome. 

? Replantation is done for hands or fingers that have been completely severed from the body to restore as much function as possible.

Associated Risks 

Possible complications you may experience are: 

• Bleeding from the wound. 
• Surgical site infection. 
• Injury to nerves and tendons. 
• Allergies to surgical materials like anaesthetic agents. 
• Scarring of the incision site. 

Recovery and Long-term Outcome 

The hands are highly pain-sensitive, and pain may be severe enough to require analgesics. To reduce movements and allow the repairs to hold firmly, you may need to wear a splint. Rehabilitation is also necessary to achieve maximal use of your hands after the procedure. Success rates depend on the type of deformity, and complete recovery may take months to years. 

Why Choose Dr Nathan Stewart? 

Dr Nathan Stewart is a fellow of the Royal Australasian College of Surgeons [FRACS] in Plastic and Reconstructive Surgery and a Consultant Specialist Plastic Surgeon with more than 14 years of experience treating advanced hand and wrist reconstruction at Royal Perth Hospital and Sir Charles Gairdner Hospital. With his team of highly skilled surgical specialists, he delivers professional expertise and support from planning to recovery. Contact Dr Stewart and his team today for a unique experience.