Hand and Microsurgery
The treatment method varies depending on the degree of the wound, the time that passed by after the accident, the degree of dirt. Especially with the wounds that happened along with tendons and nerve cuts, are more important. Even though there are systems to determine the treatment principles, the valid one is to choose the appropriate method according to the type of accident. The most important principle is the method to give back the hand its functions as much as possible.
The most common one is the simple tendon cuts. Tendons are fybrose white or colored band structures that lie between the bone and flesh. The motion that is formed by the contraction of the muscle is transferred to the bone by the tendon. The bone moves dependent on the joint it is tied to. When the tendon is cut the motion can not be transferred. However there are other factors. These are the integrity of the bone, the situation of the joint, the integrity of the skin, and integrity of nerve tissue that transfers the signals. Thus, in order to have a full function of tendon, the other factors must be healthy. The nerve and the other structures are diagnosed separately. In short damage inspection is done.
Depending on the type of injury, the surgery is done immediately or electively. The nerves or vein cuts must be fixed urgently. Hand surgeries must be determined under conditions where there is no blood and all the structures that have been injured must be investigated. So the complex structure of the hand is clear and a healthy operation can be carried out.
During operation, all the parts that have been injured (tendon, nerve, veins) are fixed with appropriate sewing material. The stitches must be more durable than normal stitches.
These stitches are done by special techniques. The important thing is to have sufficient connection between tendons, veins and nerves and the tissues around the stitches must be healthy. Tendon moves by slipping in a cover. In some points there are horizontal band structures called “pulley” that prevent the tendon to leave the bone. Some pulleys must be especially protected during surgery and sometimes need to be fixed. The tendons must be checked during surgery if they are moving freely. The tourniquet is opened after surgery and the blood circulation is set free and sensitive bleeding control is done, the bleeding veins are tied and bleeding is stopped. The injuries characterized by tendon, vein and nerve smashes are harder to treat. In the early stages tendon, vein and nerves from other parts of the body are transferred and fixed by grafts. If time has passed by and there is tissue loss, first prosthesis in the shape of a tendon with a silicone structure is put and the tendon cover will be formed in 3 months. In the second surgery the silicone prosthesis is taken out and tendon graft is put instead.
The hand must be held still in order to have the tendons, nerves and veins to heal. However, passive moves must be started after a while. Passive moves are applied by springs or plastic force artificially. This prevents the tendon to stick onto the tissues and the joints to work and gain health. In the latter stage, the active moves start according to the recommendations of the surgeon. Active moves are moves that the patient does consciously by moving the fingers or the hand.
The treatment is carried on with a physiotherapy specialist after surgery. Early attempts to move the hand before there is enough healing on the tendon might result in breaking-offs. Thus trailing after surgery is very important.