Hands Reconstructive surgery & reha.pptx

Physical Therapy (Orthopedics)

1. Reconstructive Surgery of Hand By Amrita Mukherjee Lecturer, NILD

2. What is hand reconstruction? Hand reconstruction may require the transfer of tissue (either from your own body or from a donor) to close large wounds. We use microvascular surgery to reattach blood vessels from the flaps to your hand to provide skin coverage and promote healing.

3. This reconstruction includes 7 individual operations that are performed in the following order: split flexor pollicis longus -extensor pollicis longus distal thumb tenodesis , (2) reconstruction of passive interossei , (3) thumb CMC arthrodesis (4) brachioradialis -flexor pollicis longus tendon transfer, (5) extensor carpi radialis longus -flexor digitorum profundus tendon transfer, (6) EPL tenodesis , and (7) extensor carpi ulnaris tenodesis .

4. Indications of Hand Reconstruction Surgery Hand reconstruction surgery is performed for a variety of indications and purposes, all aimed at restoring the function, aesthetics, and quality of life of individuals who have experienced traumatic injuries, congenital deformities, or other conditions affecting their hands. Some of the common indications and purposes of hand reconstruction surgery include: Traumatic Injuries:  Hand reconstruction surgery is often indicated for individuals who have sustained traumatic injuries to their hands, such as fractures, dislocations, crush injuries, amputations, and lacerations. The surgery aims to repair damaged bones, tendons, nerves, blood vessels, and soft tissues to restore optimal hand function.

5. Congenital Deformities:  Individuals born with congenital hand deformities, such as syndactyly (fused fingers), polydactyly (extra fingers), or brachydactyly (shortened fingers), may undergo hand reconstruction surgery to correct these abnormalities. The surgery aims to improve hand appearance and function. Nerve and Tendon Injuries:  Damage to nerves and tendons can lead to loss of sensation, movement, and strength in the hand. Hand reconstruction surgery can repair or graft damaged nerves and tendons to restore function and sensation. Amputations:  Hand reconstruction surgery can be used to reattach amputated fingers or hands, a procedure known as replantation . Surgeons use microsurgery techniques to reconnect blood vessels, nerves, and tissues to restore blood supply and function to the reattached body part.

6. Arthritis and Joint Problems:  Hand reconstruction surgery may be performed to ease pain and improve function in individuals with severe arthritis or joint problems. Joint reconstruction procedures, such as joint replacement or fusion, can restore mobility and reduce discomfort. Tumor Removal:  Tumors in the hand, whether benign or malignant, may require surgical removal. Hand reconstruction surgery is often performed after tumor removal to restore hand function and aesthetics. Burns and Soft Tissue Injuries:  Severe burns or other soft tissue injuries to the hand can lead to scarring and functional limitations. Hand reconstruction surgery may involve skin grafts, flap procedures, or tissue expansion to restore skin coverage and function. Carpal Tunnel Syndrome:  Hand reconstruction surgery can be indicated for conditions like  carpal tunnel syndrome  , a condition characterized by pressure on the median nerve in the wrist. Surgery aims to relieve pressure on the nerve and restore hand function.

7. Dupuytren's Contracture:  This condition involves the thickening and tightening of connective tissue in the palm, leading to finger contractures. Hand reconstruction surgery can release the contracted tissue and restore finger mobility. Aesthetic Concerns:  Hand reconstruction surgery is not limited to functional restoration; it also addresses aesthetic concerns. Procedures may involve improving the appearance of scars, enhancing symmetry, and achieving natural-looking results. Nail Bed Injuries:  Trauma to the nail bed can lead to deformities in the nails. Hand reconstruction surgery can repair and reconstruct the nail bed to restore normal nail growth. Degenerative Conditions:  Conditions like rheumatoid arthritis or  osteoarthritis  can lead to joint degeneration and hand deformities. Hand reconstruction surgery can help manage these conditions and restore hand function.

8. Steps involved in Hand Reconstruction Surgery During hand reconstruction surgery, several steps and procedures will be undertaken to address the specific issues affecting your hand. The exact details of the surgery will depend on your individual condition, the extent of the damage, and the goals of the procedure. Here is a general overview of what may happen during hand reconstruction surgery: Anesthesia:  You will be given anesthesia to ensure you are comfortable and pain-free during the procedure. The type of anesthesia used (local, regional, or general) will be discussed and determined before the surgery. Incision:  The surgeon will make carefully planned incisions based on the specific procedure(s) being performed. Incisions may be made on the palm, back of the hand, or other areas as needed to access the affected structures.

9. Soft Tissue Reconstruction:  If there are soft tissue injuries or deformities, the surgeon will carefully address these issues. This may involve repairing tendons, ligaments, muscles, and other soft tissues. In some cases, tissue from other parts of your body may be transferred (flap surgery) to reconstruct lost tissue. Bone Reconstruction:  If there are fractures, bone deformities, or joint problems, the surgeon will realign and stabilize bones using screws, plates, or other fixation devices. Joint reconstruction or replacement may also be performed if needed. Nerve Repair:  If there is nerve damage, the surgeon may perform nerve repair or grafting to restore sensation and function. Microsurgical techniques may be employed to delicately suture damaged nerves. Vascular Repair:  In cases of vascular injury, the surgeon will repair damaged blood vessels to restore blood flow and ensure proper healing.

10. Skin Closure:  Once the necessary repairs and reconstructions are completed, the surgeon will carefully close the incisions using sutures, staples, or other closure methods. Dressing and Splinting:  Dressings, bandages, and possibly a splint or cast may be applied to protect and support the hand during the initial healing phase. Recovery and Observation:  After the surgery, you will be taken to a recovery area, where medical professionals will monitor your vital signs and ensure you are waking up comfortably from anesthesia. Post-Operative Care:  Depending on the specific procedure and your surgeon's recommendations, you may receive pain medication, antibiotics, and instructions for wound care. You'll also receive guidance on hand elevation, movement restrictions, and when you can resume certain activities. Follow-Up Appointments:  You'll schedule follow-up appointments with your surgeon to monitor your healing progress. These appointments are essential for ensuring that your hand is healing well and that any necessary adjustments to your recovery plan are made.

11. Recovery after Hand Reconstruction Surgery Recovery after hand reconstruction surgery is a gradual process that involves proper wound healing, rehabilitation, and close follow-up with your healthcare team. The duration and specifics of your recovery will depend on the type of surgery performed, the extent of the reconstruction, and your overall health. Here are the general stages and considerations for recovery after hand reconstruction surgery: Immediate Post-Operative Period: Hospital Stay:  The length of your hospital stay will vary depending on the complexity of the surgery and your overall health. You may need to spend a few hours to a few days in the hospital for observation and initial wound care. Pain Management:  You will be prescribed pain medications to manage discomfort during the initial stages of recovery.

12. Wound Care:  Follow your surgeon's instructions for wound care, dressing changes, and keeping the surgical area clean and dry. Immobilization:  Depending on the procedure, you may need to wear a splint, cast, or brace to immobilize and protect the hand. This helps facilitate healing and prevent undue stress on the surgical site. Early Recovery Phase: Home Care:  Once discharged, you will need assistance with daily activities as your hand heals. Follow any restrictions on hand movement and weight-bearing that your surgeon provides. Elevation:  Keeping your hand elevated helps reduce swelling and promote healing. Follow your surgeon's guidance on how often and for how long to elevate your hand. Physical Therapy:  You will likely begin physical therapy and occupational therapy sessions to regain hand strength, flexibility, and function. Therapy may involve exercises, stretching, and techniques to improve range of motion.

13. Mid-Stage Recovery: Stitches or Staples Removal:  If your sutures or staples need to be removed, your surgeon will schedule an appointment for this procedure. Scar Management:  As your incisions heal, you'll want to follow scar care instructions provided by your surgeon. This may include using silicone gel sheets, massaging the scar, and protecting it from sun exposure. Progressive Activities:  With the guidance of your healthcare team, you'll gradually increase the use of your hand for daily activities and work toward regaining functional independence.

14. Advanced Recovery: Strengthening and Conditioning:  As your hand heals and gains more strength, your therapy sessions will focus on advanced exercises and activities to further enhance hand function and dexterity. Return to Work and Activities:  Depending on the nature of your occupation and the extent of the surgery, you'll work with your surgeon and therapist to determine when you can safely return to work and resume recreational activities. Long-Term Follow-Up:  Regular follow-up appointments with your surgeon are important to monitor your progress, address any concerns, and make any necessary adjustments to your recovery plan.

15. Lifestyle changes after Hand Reconstruction Surgery After undergoing hand reconstruction surgery, certain lifestyle changes and adjustments may be necessary to support your recovery and ensure the best possible outcome. These changes can help promote healing, prevent complications, and gradually restore function to your hand. Keep in mind that the specific lifestyle changes will depend on the type of surgery performed and your individual circumstances. Here are some general guidelines to consider: Follow Medical Instructions:  Adhere to your surgeon's post-operative instructions and recommendations. This includes taking prescribed medications as directed, attending follow-up appointments, and following any restrictions on hand movement and weight-bearing. Wound Care:  Proper wound care is essential for preventing infection and promoting healing. Keep the surgical area clean, follow dressing change instructions, and notify your surgeon if you notice any signs of infection, such as redness, swelling, or drainage.

16. Physical Therapy and Rehabilitation:  Engage diligently in the prescribed physical therapy and occupational therapy exercises. These exercises are crucial for regaining hand strength, flexibility, and function. Consistency is key to achieving optimal results. Hand Elevation:  Elevating your hand regularly, especially during the initial stages of recovery, can help reduce swelling and promote circulation. Follow your surgeon's recommendations for proper hand elevation techniques. Avoid Overexertion:  While it's important to engage in rehabilitative exercises, avoid overexerting your hand or performing activities that could strain the surgical area. Gradually increase the intensity of your activities under the guidance of your healthcare team. Balanced Nutrition:  Consuming a healthy diet rich in vitamins, minerals, and nutrients supports the body's healing process. Adequate protein intake is particularly important for tissue repair and recovery. Hydration:  Stay well-hydrated to support overall healing and minimize the risk of complications.

17. Stress Management:  Reducing stress and maintaining a positive outlook can contribute to a smoother recovery. Engage in relaxation techniques, meditation, or activities you enjoy. Quit Smoking:  If you smoke, consider quitting or reducing smoking. Smoking can impair wound healing and increase the risk of complications. Medication Management:  If you're taking any medications, follow your doctor's recommendations regarding their use. Some medications can affect healing and recovery. Assistive Devices:  Depending on your situation, your surgeon may recommend using assistive devices such as splints, braces, or adaptive tools to support hand function during daily activities. Gradual Resumption of Activities:  Consult your surgeon before resuming activities that may put stress on your healing hand. Gradually reintroduce activities like driving, lifting, and sports under medical guidance.

18. Sleep Position:  Adjust your sleep position to minimize pressure on the surgical site. You may need to sleep with your hand elevated or use pillows for support. Sun Protection:  Protect healing scars from sun exposure to prevent hyperpigmentation . Apply sunscreen or cover the scar when exposed to sunlight. Open Communication:  Maintain open communication with your healthcare team. If you have any concerns or experience changes in your recovery, don't hesitate to reach out to your surgeon or therapist.

19. PHYSIOTHERAPY MANAGEMENT All it takes are simple exercises that are focused on stretching and fortifying your muscles to improve strength and flexibility. Here are several hand exercises designed to do just that. However, always consult your doctor before beginning any post-surgical exercises: Tight Fist Exercise --  Make a fist, clenching tightly. Be sure to bend your fingers as much as you can and place your thumb around the outside of your fingers. Do this for several seconds, then straighten and spread your fingers as far apart as you can. You can also grip a ball or other round, solid object in the palm of your hand to increase resistance. Finger Bend Exercise –  Extend your fingers, keeping them straight. Now gently bend them at the knuckles as much as possible. Then strengthen your fingers and repeat 50 times each hour. The purpose of this exercise is to improve muscle strength and range of motion.

20. Finger to Finger Exercise  – Touch you thumb to your index finger to form an “O.” Then straighten your fingers and touch your middle finger with your thumb. Repeat this with each finger and perform this exercise several times each day. Thumb Bend Exercise  – Start with your fingers and thumb straight and close together. Then slowly bend your thumb toward your pinky finger, crossing the palm of your hand and touching the base of the finger. If you can’t extend your thumb that far, stretch your thumb as far as you can. Finger Tap Exercise  – Place your hand on a flat surface, palm facing down. Raise you thumb. Lower your thumb. Raise your index finger. Lower your index finger. Repeat these motions with each finger of your hand. Wrist Stretch Exercise  – Supporting your forearm with one hand, bend your wrist forward and backward as far as possible about 10 times.

21. Forearm Rotation Exercise  – Bend your arm while holding your elbow close to your side. Be sure your hand and fingers are straight with your fingers close together. Now, with your palms facing down, rotate your hand until your palms are facing upward. Then rotate your hand back toward the floor. Repeat as many times as you feel comfortable.

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