People suffering from a variety of conditions—which affect the way they work and perform life’s daily activities—are possible candidates for one of our hand procedures. Our physicians are trained and experienced in hand reconstructive procedures, including finger replantation, nail bed reconstruction, tendon repair, and carpal tunnel syndrome release.
Finger Replantation is the surgical reattachment of a digit after is has been completely severed. Our physicians recommend this procedure only if the replanted finger is expected to function without pain. They will thoroughly explain each step of this surgical procedure, and will evaluate how much function is expected to return once the replantation has been completed. The goal, of course, is to return as much use of the injured area as possible.
As the necessity of a replantation procedure is caused by a traumatic experience, timing of the procedure is critical. The surgical team at Regeneris Medical has decades of expertise in successful replantation, thus understanding both the physical and emotional care our patients require and deserve.
The risks of finger replantation surgery include:
- Stiffness in finger joints
- Death of replanted tissue
Finger replantation surgery is intricate and complex. Depending on the damage sustained to both the severed digit and the injury site, this surgery can be a long process. The surgical steps include:
- Damaged tissue is carefully removed.
- The bone ends are shortened, then rejoined with pins, wires or plates and screws. This allows the two rejoined parts to be held in place for tissue restoration.
- The muscles, tendons, arteries, nerves and veins are then repaired. Sometimes, grafts or artificial spacers on bone, skin, tendons and / or blood vessels are required as well.
You play an important role in your own recovery. Understanding the care required for optimal results is essential. This means that you must communicate any concerns or questions you have to our care team. In addition to adhering to your post-surgical care instructions, the following are points to keep in mind:
- Avoid smoking, as it may cause loss of blood flow to the replanted parts
- Elevate your wound site above heart level to increase blood circulation
- Use of the replanted part partially depends on the regrowth of sensory nerves (touch) and motor nerves (movement). Nerves grow approximately two inches per month.
Healthy living, including getting enough sleep and eating foods high in vitamins, minerals and protein, is only half of your rehabilitation. You may be asked to wear a temporary brace for a while, in order to protect your wound site, while allowing for movement. Physical therapy will most certainly be prescribed, and is critical to regaining the use of your finger(s). Consistently attending your physical therapy sessions, and following the program created by your physical therapist will keep your joints from becoming stiff; will keep your muscles mobile; and will keep scar tissue to a minimum.
At Regeneris Medical, we understand how the traumatic events of life affect our patients. We are committed to providing the highest quality of care available. We want to help you regain the quality of life your deserve.
Nail Bed Reconstruction
Most of us have smashed our fingers in a door, or accidentally hit them as we hammered a nail into the wall. We wince in pain, may shout an “expressive” word or two, and then… we move on, assuming after a day or two, the throbbing and soreness will subside. Purple bruising under the fingernail may occur, which means there is a pooling of blood underneath the nail.
However, if the pain persists and finger usage has decreased, it is probable that the nail bed itself has been damaged and is in need of reconstruction. Because we consider smashing our fingers to be trivial, we delay seeking the required medical attention.
One of the first things done in treating a nail bed injury is taking an x-ray. After assessing the damage discovered, our physician will recommend treatment, which may include:
- Drilling a small hole into the nail to relieve the pressure caused by the pooling of blood. This will also provide pain relief. A local anesthetic will be administered before the procedure begins, ensuring you feel no pain during the reconstruction.
- Depending on the severity of the injury, and the condition of the nail bed, surgery may be required. Of course, this determination will be made upon examination.
- Regardless of the procedure, a splint may be used for a few days afterwards to enable proper healing to occur.
In most cases, your nail bed will return to normal within a few weeks, but it will be much longer for the fingernail itself. Keep in mind that it takes three to six months for a fingernail to completely regrow.
Tendons are the soft, band-like tissues that connect muscle to bone. When muscles contract, tendons pull bones in the requested direction and cause the joints to move. However, when tendons are damaged, through injury or accident, pain and limited mobility result. The most commonly affected areas of tendon damage include shoulders, elbows, ankles, knees and fingers. Sport injuries, lacerations (cutting your finger while cooking, for example) and rheumatoid arthritis are all ways your tendons can be damaged.
After examination of the injury, and through candid conversation with you, our expert surgeons will determine the treatment that will yield the most optimal outcome. You can gain a better understanding of what that outcome may be by asking your doctor questions. More often than not, surgery is required. The steps involved in that surgery include:
- Making a small incision, as determined by MRI and physical examination
- Using small cameras for visual acuity, the torn tendon ends are sewn together
- Examining the surrounding tissue (blood vessels, nerves) for further injury, and repairing if necessary
- Closing the incision, then bandaging the wound site
Keep in mind the following:
- Scar tissue may form, preventing joints from moving smoothly
- Some range of motion may be lost
- General stiffness in joints may occur
- There may be a higher risk of re-tearing the tendon
You are the best gauge of a positive outcome. Physical therapy will be prescribed. In order for you to achieve the best possible results, you must keep at it. A full, or nearly full, recovery can occur with proper and consistent effort in your physical therapy treatment plan.
Carpal Tunnel Syndrome Release
Carpal Tunnel Syndrome (CTS) occurs when the median nerve, which runs from the forearm to the palm of the hand, becomes pressed or squeezed at the wrist. The carpal tunnel is a narrow passageway of ligament and bones at the base of the hand, and encloses the median nerve and the tendons that bend the fingers. When these tendons become irritated or swollen, the median nerve becomes compressed, resulting in numbness, weakness and sometimes pain in the hand and wrist. In the past, CTS was thought to be caused by repetitive motion or over usage. However, it is has been determined that those who suffer from CTS have a congenital predisposition – in other words, it runs in the family.
If you have tried various treatments, such as wearing a splint, doing physical therapy, and taking anti-inflammatory medication to reduce swelling and pain, but your symptoms persist, surgery may be the next step. The procedure is uncomplicated, and is done under local anesthetic in our outpatient facility. This 30 minute procedure includes the following steps:
- Making a small incision in the palm of the hand near the wrist
- Cutting the ligament that covers the carpal tunnel, easing the pressure on the median nerve
- Closing the wound
Your recovery will take several weeks to several months. You will wear a splint to keep your hand and wrist immobile. Physical therapy will be prescribe, and you may need to elevate your hand during sleep to decrease swelling.