Introduction to
Hand and Brachial Plexus Surgery:
Hand and brachial plexus surgery focuses on treating conditions and injuries affecting the hand, wrist, and the network of nerves known as the brachial plexus. These surgeries address a variety of issues, such as nerve injuries, tendon repairs, fractures, and congenital deformities. Brachial plexus injuries, often resulting from trauma, can lead to significant functional impairments. Surgeons in this field employ advanced techniques to restore movement, strength, and sensation, improving patients' quality of life and enabling them to regain their independence.
Types of Surgeries
Treatment Available
Open Carpal Tunnel Release:
A surgical procedure that involves making a small incision in the palm of the hand to access and release the transverse carpal ligament, relieving pressure on the median nerve and alleviating symptoms of carpal tunnel syndrome.
Endoscopic Carpal Tunnel Release:
A minimally invasive surgical technique that uses a small camera (endoscope) and specialized instruments inserted through a small incision in the wrist to visualize and release the transverse carpal ligament, providing relief from carpal tunnel syndrome symptoms with less scarring and quicker recovery compared to open surgery.
Conditions
Carpal tunnel syndrome (CTS)
Numbness, tingling, and pain in the hand and fingers
Weakness in the hand muscles
Treatment Available
Open Tendon Repair:
This surgical procedure entails making a direct incision over the injured tendon to access and mend it, typically applied for larger or more intricate tendon injuries.
Endoscopic Tendon Repair:
A minimally invasive surgical method that utilizes a small camera (endoscope) and specialized instruments inserted through minor incisions to visualize and mend the tendon. It results in smaller scars and potentially faster recovery compared to open surgery.
Suture Repair:
This technique involves stitching together the torn ends of the tendon using sutures, enabling them to heal and regain strength over time. It can be performed via open or endoscopic methods, depending on the injury’s severity and the surgeon’s preference.
Tendon Grafting:
When the tendon is severely damaged or cannot be directly repaired, this approach involves using a tendon graft from another part of the body or a donor source to substitute the injured tendon and restore function.
Tendon Transfer:
Involves redirecting a healthy tendon from its original attachment to a new location to compensate for a damaged or non-functional tendon, thereby restoring movement and function to the affected area.
Conditions
Tendon lacerations or ruptures
Tendon injuries from trauma
Degenerative tendon conditions
Treatment Available
Fasciectomy:
Surgical removal of the thickened fascia causing the contracture. This can be partial (segmental) or total.It is considered the most thorough and effective surgical option for severe Dupuytren’s contracture.
Fasciotomy:
A less invasive surgical method that involves making small incisions in the affected tissue to release tension and allow affected fingers to straighten. It is typically utilized for milder cases of Dupuytren’s contracture or when the condition recurs following a previous surgery.
Dermofasciectomy:
A more extensive surgical procedure involving the removal of both the thickened fascia and overlying skin, followed by skin grafting to cover the area where the tissue was removed. It is generally reserved for cases of Dupuytren’s contracture with significant skin involvement or recurrence post previous surgeries.
Conditions
Dupuytren’s contracture
Thickening and tightening of the hand’s connective tissue
Flexion contractures of the fingers
Treatment Available
Surgical Intervention:
For more severe hand injuries, surgical treatment may be necessary. This can include procedures such as microsurgical reconstruction, tendon repair, nerve repair, fracture fixation, or joint reconstruction to restore function and mobility in the hand.
Replantation:
Reattachment of amputated fingers or hands.
Flap Surgery:
Transferring tissue to cover defects and promote healing.
Nerve Repair:
Repairing or grafting damaged nerves.
Bone Fixation:
Stabilizing fractures using plates, screws, or pins.
Conditions
Traumatic hand injuries
Amputations of fingers or hands
Complex fractures and bone injuries
Nerve damage in the hand
Treatment Available
Surgical Repair:
In instances of more severe brachial plexus injuries, surgical intervention becomes necessary. This can encompass various methodologies like nerve grafting, nerve transfers, and muscle transfers to rectify damaged or injured nerves and reinstate functionality to the affected limb. The objective of surgical repair is to enhance function, mobility, and the overall quality of life for individuals grappling with brachial plexus injuries.
Nerve Grafts:
Using nerves from other parts of the body to repair damaged ones.
Nerve Transfers:
Redirecting a nearby healthy nerve to restore function.
Muscle Transfers:
Moving muscles to improve arm and hand movement.
Conditions
Brachial plexus injuries (nerve damage in the shoulder, arm, or hand)
Paralysis or weakness in the arm
Loss of sensation in the arm or hand
Treatment Available
Open Carpal Tunnel Release:
A surgical procedure that involves making a small incision in the palm of the hand to access and release the transverse carpal ligament, relieving pressure on the median nerve and alleviating symptoms of carpal tunnel syndrome.
Endoscopic Carpal Tunnel Release:
A minimally invasive surgical technique that uses a small camera (endoscope) and specialized instruments inserted through a small incision in the wrist to visualize and release the transverse carpal ligament, providing relief from carpal tunnel syndrome symptoms with less scarring and quicker recovery compared to open surgery.
Conditions
Carpal tunnel syndrome (CTS)
Numbness, tingling, and pain in the hand and fingers
Weakness in the hand muscles
Treatment Available
Open Tendon Repair:
This surgical procedure entails making a direct incision over the injured tendon to access and mend it, typically applied for larger or more intricate tendon injuries.
Endoscopic Tendon Repair:
A minimally invasive surgical method that utilizes a small camera (endoscope) and specialized instruments inserted through minor incisions to visualize and mend the tendon. It results in smaller scars and potentially faster recovery compared to open surgery.
Suture Repair:
This technique involves stitching together the torn ends of the tendon using sutures, enabling them to heal and regain strength over time. It can be performed via open or endoscopic methods, depending on the injury’s severity and the surgeon’s preference.
Tendon Grafting:
When the tendon is severely damaged or cannot be directly repaired, this approach involves using a tendon graft from another part of the body or a donor source to substitute the injured tendon and restore function.
Tendon Transfer:
Involves redirecting a healthy tendon from its original attachment to a new location to compensate for a damaged or non-functional tendon, thereby restoring movement and function to the affected area.
Conditions
Tendon lacerations or ruptures
Tendon injuries from trauma
Degenerative tendon conditions
Treatment Available
Fasciectomy:
Surgical removal of the thickened fascia causing the contracture. This can be partial (segmental) or total.It is considered the most thorough and effective surgical option for severe Dupuytren’s contracture.
Fasciotomy:
A less invasive surgical method that involves making small incisions in the affected tissue to release tension and allow affected fingers to straighten. It is typically utilized for milder cases of Dupuytren’s contracture or when the condition recurs following a previous surgery.
Dermofasciectomy:
A more extensive surgical procedure involving the removal of both the thickened fascia and overlying skin, followed by skin grafting to cover the area where the tissue was removed. It is generally reserved for cases of Dupuytren’s contracture with significant skin involvement or recurrence post previous surgeries.
Conditions
Dupuytren’s contracture
Thickening and tightening of the hand’s connective tissue
Flexion contractures of the fingers
Treatment Available
Surgical Intervention:
For more severe hand injuries, surgical treatment may be necessary. This can include procedures such as microsurgical reconstruction, tendon repair, nerve repair, fracture fixation, or joint reconstruction to restore function and mobility in the hand.
Replantation:
Reattachment of amputated fingers or hands.
Flap Surgery:
Transferring tissue to cover defects and promote healing.
Nerve Repair:
Repairing or grafting damaged nerves.
Bone Fixation:
Stabilizing fractures using plates, screws, or pins.
Conditions
Traumatic hand injuries
Amputations of fingers or hands
Complex fractures and bone injuries
Nerve damage in the hand
Treatment Available
Surgical Repair:
In instances of more severe brachial plexus injuries, surgical intervention becomes necessary. This can encompass various methodologies like nerve grafting, nerve transfers, and muscle transfers to rectify damaged or injured nerves and reinstate functionality to the affected limb. The objective of surgical repair is to enhance function, mobility, and the overall quality of life for individuals grappling with brachial plexus injuries.
Nerve Grafts:
Using nerves from other parts of the body to repair damaged ones.
Nerve Transfers:
Redirecting a nearby healthy nerve to restore function.
Muscle Transfers:
Moving muscles to improve arm and hand movement.
Conditions
Brachial plexus injuries (nerve damage in the shoulder, arm, or hand)
Paralysis or weakness in the arm
Loss of sensation in the arm or hand
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