Hand Reconstruction

Hand reconstruction means rebuilding a hand that has lost function after a severe injury, an infection or an earlier operation that did not go as hoped. The wounds may have healed and the bones may have united, yet the fingers still do not move, the skin is tight and scarred, or the hand cannot grip.

Reconstruction combines several techniques, often over more than one operation: replacing scarred skin with healthy skin using flaps, repairing or grafting nerves, tendon transfers, and joint procedures.

This gentleman fell from a tree, breaking both bones of his forearm and suffering a large wound near the wrist. He was first treated at a free hospital. The wound healed and the fractures united, but he could not move his fingers. He then came to us with his friends, and staged surgery was carried out.

In the first stage, the scarred forearm skin was removed and replaced with healthy skin from the arm, using a procedure called a lateral arm free microvascular flap. In the next stage, a tendon transfer was done. This restored his full finger movements.

He is now gainfully employed and owns his house and several properties. From jobless to gainful employment: a transformation made possible by surgical technology, a clear understanding of the problem and careful execution.

A badly damaged hand usually has several problems at once, and they must be fixed in the right order:

1. Skin first. Tendons and nerves cannot glide or heal under thick scar. Scarred skin is replaced with healthy, well-supplied tissue, often a flap.
2. Supple joints. Stiff joints are loosened with therapy, dynamic splinting or surgery, because a tendon cannot move a joint that is stuck.
3. Movement. Once the bed is ready, tendons are repaired, grafted or transferred, and nerves are repaired or grafted.
4. Rehabilitation. Splints and therapy after each stage protect the repair and retrain the hand.

Splints for each stage are designed and made in-house at the clinic.

Reconstruction may help people with:

• an old injury that healed with a stiff, weak or non-working hand,
• crush, machine or road-accident injuries with lost skin, tendons or nerves,
• hands left scarred by infection,
• loss of function after earlier surgery elsewhere.

For deformities caused by burns, or bones that healed crooked, see deformity correction and burns.

Book a consultation to have your hand assessed.