Hand Surgery

We all use our hands every day for various tasks. Considering that they are always exposed and in plain sight, functional damage and aesthetic degradation due to hand injury or illness can be especially troubling. At Alfa Medic General Hospital we have several renowned experts in the field of aesthetic plastic surgery of the hand.

Our medical services related to hand surgery most commonly include the following diagnoses:

• Dupuytren’s contracture
• Carpal tunnel syndrome
• Loge de Guyon syndrome
• Surgery of rheumatic changes of hands and joints
• Correction of complex hand injuries following serious injuries and after primary care in hospitals and public buildings, such as bone and soft tissue (tendons, nerves, blood vessels)
• Reconstruction of peripheral nerve extremities
• Congenital limb deformities
• Surgical treatment of muscle and nerve damage of the forearm

Dupuytren’s contracture

The acquired contracture of subcutaneous fascia and fibers is known as “palmar fibrosis” and can be concentrated on one finger, more fingers and in the palm area. With this disease, the patient is not able to stretch out the affected finger of the hand. This change affects the connective tissue of the palm, resulting in a limited movement of fingers, with a tendency to cause spontaneous and progressive bending towards the palm.

In this case, the operating goal is to, as much as possible, completely eliminate the diseased and thickened degenerative nodes. The operation is performed with partial hand anesthesia (plexus block), so it only affects the anesthetized limb.

After surgery, the hand is placed in a short immobilization cast, followed by physiotherapy exercises. Hospitalization is 1 – 2 days.

Carpal tunnel syndrome

This disease of the peripheral nerves (median nerve) causes numbness or so-called hand tingling (thumb, index finger, middle finger and half of the ring finger). It is essential that the patient first visits a neurologist, who confirms this diagnosis. Such manifestations often occur at night, so when the patient wakes up, there is a feeling of numb hands and he/she must shake or even bathe in cold or hot water to stop the numbness.

The described symptoms are due to pinching of the nerve that passes through the middle of the forearm, and from the middle of the wrist reaches the palm, from where it sends its fibers to the sensitive fingertips. At the entrance of the hand it passes through the perforated anatomical tunnel which can be pressed, causing the described symptoms to occur. By cutting a small incision in the area of compression the nerve pressure is relieved, and so the carpal roof completely opens and releases strong connective fibers. The operation can be performed either endoscopically or through a conventional method. A cut is 2 – 3 cm.

In certain, rare cases, a temporary phenomenon can occur, and is described as the feeling of irritation of nerves even some time after the operation. This happens especially when the patient has been delaying the operation for a long time. In most cases (over 90% of treated patients) symptoms disappear immediately after surgery.

The operation is done in partial anesthesia of the treated limb. Hospitalization lasts one day.

Loge de Guyon syndrome

This disease of the peripheral nervous system refers to another nerve in the hand (Ulnar nerve) and has the same symptoms described in the previous section. Localization of symptoms are in the region of the outer half of the ring finger and little finger. Like in the previous section, these symptoms also occur because of a pinched nerve in the area of entry from the hand to the forearm. The operation is performed under partial anesthesia of the affected limb, through microsurgical intervention and with the help of a microscope or magnifying glass.

After the surgery is performed, you must stay at the clinic for one day. Isolation of the hand is inevitable for 5 – 7 days. You can go back to work after 14 days.

Surgery of rheumatic hand changes

Thumb arthritis or joint disease of the thumb is not rare. Because of the frequency of movements of this joint, there is often complaint of pain, which is why patients seek medical attention. Depending on the severity of the disease and the patient’s age, at your disposal are a variety of surgical procedures.

In younger patients, with minor changes in the cartilage, we can treat the condition with the so-called joint denervation (interruption of sensory nerve fibers) method, without affecting the mobility of the joint, eliminating the transmission of pain to the central nervous system. In doing so, the patient feels no pain when moving the thumb.

In the elderly, as well as with major shortcomings in the cartilage mass joint, it is necessary to remove the metacarpal bone element, which is in direct contact with the damage. Depending on the extent of functional disorder, as well as other factors (age, occupation, patient, degree of changes), the decision is made on which type of surgery is best. The operation is performed under isolated anesthesia of the diseased extremity (plexus block). Hospitalization lasts 1 – 3 days. The patient wears a cast with an isolated thumb and forearm for 5-6 weeks.

Rheumatic hands changes are so complex and diverse that it is best to approach each case on an individual basis, and to create a customized treatment approach. If you are suffering from any changes of a rheumatic nature, please contact us for an individual consultation where we can discuss possible solutions. It is important that you provide any medical documents and radiographs that you may have.

Foto galerija: Alfa Medic opšta bolnica – Hirurgija šake
Repozicija metakarpofalangealnog zgloba palca. Pacijent došao usled sportske povrede palca