The hand is unique as Skin, Bone, Joints, Flexor Tendons, Extensor Tendons, Nerves and Blood Vessels are in close proximity to each other. Very often, injuries of one structure will affect another.
The hand is also one of the most frequently injured parts of the body.
The scope for repair of traumatic hand injuries is quite vast and include the following, all of which Dr Lim is familiar with:
- Repair of Lacerations
- Hand fracture fixation
- Microsurgical nerve repair
- Microsurgical artery/ vein repair
- Flexor tendon repair
- Extensor tendon repair
- Nailbed repair
- Fingertip resurfacing
Skin and Soft Tissue
Skin lesions may occur in the hands, both benign and malignant.
Depending on the site of the lesion (dorsal hairy skin vs. hairless palmar skin) these lesions may be excised for biopsy with a CO2 laser or require formal excision with a scalpel.
Post excisional defects may need resurfacing with flaps or skin grafts as skin of the hands in always at a premium.
Hand Lumps and Bumps
These may be derived from skin, bone, joint, nerves, vessels or tendons and each needs specific approach for removal.
Pre-operative investigations (X-Rays, Ultrasound scas, CT or MRI scans) may be needed to define the lesion and how it may be involved with the structures in the hand.
Scars on the hands are especially debilitating when they cross joints and cause contractures which limit finger mobility and function.
Scar contracture release may necessitate lengthening procedures like Z-plasties.
This scarring disorder results in tight fibrous cords on the palms of the hand which gradually cause the fingers to contract in flexion, severely affecting hand function.
The Dupuytren’s cords cause underlying soft tissue distortion which may also result in displacement of crucial nerves and arteries, rendering them easily traumatised and injured.
MacFarlane’s Fasciectomy remains the gold standard for Dupuytren’s contracture release.
Trigger Digits, De Quervain’s Tenosynovitis
This repetitive strain disorder with thickening of flexor tendon pulleys (Trigger Digits) or the extensor retinaculum (De Quervain’s Tenosynovitis) restricts the smooth excursion of the contained tendons which is painful and can restrict hand function.
The first line of treatment is steroid injections.
Open release via carefully placed skin crease incisions may be required if conservative treatment fails.
Carpal Tunnel Syndrome
The medial nerve runs through the narrow carpal tunnel with 9 other tendons and can be easily compressed in a variety of situations.
Median nerve compression results in sensations of numbness and tingling, and pins and needles in the hand. The small muscles of the hand can be affected, resulting in weakness.
This condition largely requires operative release via strategically placed incisions along pre-existing palmar skin creases.