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General aspects of hand surgery

Surgery of the hand requires knowledge and experience of two surgical specialties – orthopaedic and plastic surgery. This is to some extent true of all limb surgery, but is much more the case in the hand because of the complex and close relationship between the skeleton of the hand and the soft tissues around it which contain all the structures that make it work. Hand surgeons generally come from these two specialties, and have to acquire basic understanding and many skills of the other complementary specialty.

Because of the anatomy of the nerves entering the arm at the shoulder level, it is possible with local anaesthetic to produce sufficiently good anaesthesia for the majority of hand and forearm operations to be performed without general anaesthetic. This means that there is usually no reason to admit patients undergoing hand surgery to hospital overnight, unless there are special aspects of the operation or the patient’s medical condition which require observation or special treatment in the postoperative period, or drains have to be removed. Sometimes the distance from the patient’s home is in itself a reason for admission.

One of the requirements for good healing of any operation is appropriate rest of the structures involved. In the case of the hand, this often means that the hand as a whole should be rested, usually on a splint which maintains the joints in a natural resting position. This is by no means always necessary, and is at the discretion of the surgeon. Elevation is important to limit the amount of swelling that develops after any operation or injury. For the hand this means the use of a sling, and propping the hand up at night.

Depending on the nature of the operation, there may be a need for physiotherapy or splintage to help regain function. This can be hard work, and requires determination on the part of the patient. In most cases, the postoperative care, including elevation and physiotherapy is as important as the surgery itself. No elective surgery of the hand should be undertaken without adequate planning and organisation of the postoperative care.

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