The human hand is one of the most complex and efficient creations of nature, yet it is least understood by many. The importance of a hand in our lives can never be overemphasized. Still, hand injuries are one of the most neglected of all important injuries. Especially, when this hand injury happens to a laborer or a daily worker, who earns his daily bread with his hand, it is neglected most of the time. Even, well-educated and financially abled patients also fall victim to improper and inadequate treatment of hand injuries and suffer disability or deformity with compromised function of the hand.
The most common reason for this loss of functionality of the hand is a lack of awareness about plastic surgery and its crucial role in the management of hand injury patients. At Cutis Hospital, we are committed to attending to hand injury patients on an emergency basis and to delivering the best results for all hand injury patients. We have been extensively trying to create awareness about the role of plastic surgeons in hand injury treatment and the functional advantages of early intervention by a plastic surgeon.
Causes of hand injury can be broadly categorized into three main types. First and usually of lesser magnitude is the domestic reason of hand injury like crushing the finger tip in the door or drawer, knife injury in the kitchen or injury with a scissors during cutting of papers, fall of heavy objects while shifting them etc. Burns of the hand due to spillage of hot oil, water, tea or fire craker injury also account for significant number of injuries. Domestic injuries are usually of limited extent, and if attended and treated by a plastic surgeon immediately after the injury, they produce excellent functional outcome without functional disability.
However, sometimes domestic injuries also cause moderate to severe degree of hand injury. Another two reasons of hand injury account for moderate to severe type of hand injuries with variable presentation. They are road traffic accidents and factory accidents. Road traffic accidents many times lead to multiple other injuries also; like head, chest, and/or abdominal injuries. Proper treatment of hand injuries is delayed or neglected in such patients of multiple associated injuries (polytrauma) and can lead to gross functional disabilities. Factory accidents usually involve isolated hand injuries, sometimes involving both hands. Due to the isolated nature of hand injury, factory accidents offer the best opportunity to receive a specialist plastic surgeon's care from the very beginning. In any scenario, hand injury patients must be examined and treated primarily by a specialist plastic surgeon to have the best possible outcome.
Symptoms of hand injury are obvious; pain, deformity, swelling, and bleeding from the injured part account for the most obvious symptoms. However, hand injury patients sometimes have less severity of symptoms even after having a significant injury. Blunt injury (without rupture of overlying skin) and compression injury account for such cases where the magnitude of injury is much higher than what is complained by the patient and what is visible on the surface. Experienced plastic surgeons can identify such atypical injuries and treat them accordingly.
Diagnosis of hand injury is not very difficult. Patients presenting with skin laceration and bleeding are easily identified and those presenting with fractures of small bones of hand can be diagnosed by good quality and properly angled X – rays. However, detailed diagnosis of hand injury is not easy. Nerve injuries at wrist (median nerve and ulnar nerve) and tendon injuries can be missed especially when the injury is sustained by sharp objects like edge of the broken glass or knife. Certain type of fractures are also missed even after taking X – ray. And diagnosis of ligament and other soft tissue injuries require very good clinical experience along with high index of suspicion and sophisticated investigations like CT scan or MRI.
Treatment of hand injury is not limited to suturing of injured skin and fixation of fractured bones as in other injuries. Hand injury treatment is very intricate matter; because treatment of hand injury without planning and without experience can lead to the outcome worse than the natural outcome without treatment. Because the anatomy of hand is very complex and function of all structures is interdependent. So, unknowingly damaging a nearby normal structure (e.g., nerve) while doing repair of injured structure (e.g., tendon) can end in to loss of function of both and subsequent generalized loss of function of whole hand and ultimately stiff, non functional hand. Sound knowledge of anatomy, good experience of treating hand injury patients, well equipped operation theatre with I.I.T.V. (image intensifier television) facility, ability to work under magnification, experienced assistant, well versed anaesthetist and very regular long term follow up are the essential pre requisites for treatment and good result of hand injury patients.
Most of the complications of hand injury treatment are usually the result of inadequate, improper and/or delayed treatment. However, even if treated timely and under ideal conditions, some unfortunate patients of hand injury end up with complications, though much less in severity than those of the maltreated and untreated patients. Functional disability is the most frustrating of all complication of hand injury. Apart from functional disability; loss of sensations, disfigurement, stiffness, painful movements, loss of power, visible scars are important complications of hand injury.
Prevention of hand injuries can be ensured by following strict safety protocols while doing all manual activities. This is a vast topic which requires tremendous public awareness, participation of industry, government involvement and thus creating awareness at an individual level. Certain number of hand injuries still going to happen even after such awareness initiative. In that case, emphasize must be given to immediate first aid and early transportation of hand injury patients to well equipped plastic surgery set up.
Results of hand injury are very good when treated by a specialist plastic surgeon within stipulated time. However, results of hand injury do not depend on surgery alone. Post operative management and regular follow up with physiotherapy are equally important for good results. In fact, perfect combination of timely and skilful execution of surgery combined with regular and long term follow up + physiotherapy are the essence of good functional outcome of hand injury patients. Certain complex cases require the treatment to be divided in stages for better results.
Thorough pre operative counselling regarding importance of follow up and physiotherapy is very important for all hand injury patients especially complex hand injury cases.
Cutis Hospital is the best hospital for the treatment of hand injury patients. Because at Cutis Hospital, all patients of hand injury are examined primarily by a qualified and experienced plastic surgeon himself irrespective of the day and time.
After preliminary examination and evaluation of the patient, required investigations are carried out and final plan of management is made by our expert plastic surgeon. Then all aspects of patient's treatment including his injury details, investigation reports, treatment plan, post operative recovery time, protocols for follow up and physiotherapy and estimated expenses incurred in the treatment are discussed with the patient and patient's relatives by our plastic surgeon. Patient is taken to operation theatre after all formalities are completed.
All aspects of treatment including pre operative examination, operation and follow up care are exerted by the same person at Cutis Hospital. This accounts for the best, consistent and reproducible results of hand injury patients and the highest level of satisfaction of such patients at Cutis Hospital.
Dr Chintan had done my hand surgery a week back. He is so friendly and professional. The staff is also very helpful. I made the right choice to select this clinic.
The edge of a broken glass is the most sharp of all sharp objects causing hand injury. Any hand injury sustained by broken glass, must be explored in operation theatre under ideal conditions, irrespective of its external appearance. Most of these injuries have injury of underlying tendons and/or nerves and/or vessels.
Because proper evaluation of any hand injury is best carried out immediately after the injury. Same is true for the surgery and it’s results of hand injury cases provided both evaluation and surgery are carried out by a qualified plastic surgeon.
Crush injury with loss of skin, tendon or bone or loss of more than one type of tissues, electrical injuries, major burn injuries, neglected hand injuries and late presenting hand injuries require multi staged treatment.
Thorough knowledge of anatomy, proper training, ability to work under magnification, patience and fine tissue handling skills make the treatment of hand injury patient by a plastic surgeon special.
Yes. By using special technique of microvascular surgery, severed finger, thumb or multiple fingers can be reattached to the body. This plastic surgical process of reattaching the severed body part by using microvascular surgery technique, is called reimplantation.
Ideally, the severed body part must be placed in a clean, dry plastic bag and sealed in such a way that water cannot enter in to this sealed plastic bag. And then this sealed bag is placed in the middle of another container full of ice. This is the best method to transport the severed body part to the hospital.
Actually, nail is an avascular structure; means it is devoid of blood supply. Bleeding happens after nail injury due to injury of underlying nail bed. Nail bed injury can readily be repaired by using special fine instruments under magnification. The results of immediate nail bed injury are excellent and in many cases of nail bed injury repair, patients have normal nail growth.
We provide effective surgical and non-surgical treatments for all parts of the body. At Cutis Hospital, our cosmetic and plastic surgery team is committed to giving patients safe and high-quality care.
