Hand Reconstructive Surgery: What You Need to Know

Pros

• This surgery can restore a normal appearance and a greater range of functionality to fingers and hands.
• It can relieve pain by treating carpal tunnel syndrome, rheumatoid arthritis, and Dupuytren’s contracture.
• The procedure can also correct congenital (present at birth) abnormalities of the fingers and hands. 

Cons

• Like all surgical procedures, it carries risks like infection and reaction to anesthesia.
• Hand reconstructive surgery can result in some loss of feeling or movement in the hand/fingers, which may require an additional procedure to correct.

There are many procedures that fall under the umbrella of hand reconstructive surgery, including:

• Tendon repair
• Nerve repair
• Closed reduction and fixation, to repair broken or fractured bones
• Joint replacement (arthroplasty)
• Skin grafts (often called flaps)

Depending on your reason for seeking hand reconstructive surgery, your surgeon may perform a combination of these procedures.

Hand reconstructive surgery is an outpatient procedure, performed either in an accredited operating suite at your surgeon’s office or in a surgical center or hospital. It will require general anesthesia, meaning that you will be completely asleep for the duration of the procedure. 

Depending on which issues you are looking to treat, your surgeon may make incisions along the midline of the palm, extending toward the wrist, to treat carpal tunnel syndrome or repair tendons and ligaments. To correct birth defects, they may take donor tissue from elsewhere on the body for use as a graft.

Your surgeon will walk you through detailed post-op care instructions, and you’ll leave with your hand wrapped in a bandage or a splint.

The hand is very sensitive, so you can expect to feel some pain, though how much will depend on the surgical procedures that were performed. Your surgeon will likely prescribe pain medication to keep you as comfortable as possible. 

You will need to keep your hand dressings (stitches) as clean and dry as possible for a few days following surgery, until your bandages come off. You can expect a considerable amount of swelling and stiffness, which may not fully subside for a few months. 

Depending on the circumstance, your hand may remain immobilized in a splint or cast for weeks or even months following surgery. It may take anywhere from a few months to up to a year to regain full functionality and movement of the hand. 

Your doctor will likely recommend physical therapy, to increase and maintain the strength and functionality of your fingers and hand. Intensive physical therapy for the hand following hand reconstructive surgery may be required for years after surgery—and in some cases, a second surgery may be necessary.

The most common risks associated with hand surgery include infection, incomplete healing, the formation of blood clots in the hand, and a loss of feeling or range of movement in the fingers or the hand. It also comes with the risk of an adverse reaction to general anesthesia. 

It’s imperative to seek out a true hand reconstruction expert, to minimize your risks. “Make sure you go to someone who specializes in hand surgery [specifically],” advises Charleston, South Carolina, plastic surgeon Dr. William Terranova in a RealSelf Q&A. “Look for someone who is a member of either the American Society for Surgery of the Hand [ASSH] or the American Association for Hand Surgery [AASH].”