Surgery of the Hand and Upper Extremities

When performing hand surgery and surgery of the upper extremities, i.e., the wrist, forearm, elbow and shoulder, Emory plastic and reconstructive surgeons work to restore function as well as maximize cosmetic appearance. Post-procedure, division surgeons will refer patients to any necessary rehabilitative services.

Conditions Treated

Applying a variety of techniques including microsurgery (intricate and precise procedures performed under powerful magnification), surgery on the hand and upper extremities is done to treat such conditions as:

• Amputation
• Brachial plexus injuries
• Burns
• Carpal tunnel syndrome
• Congenital deformities such as syndactyly (webbed fingers) and polydactyly (extra fingers)
• Dequervain's tendonitis
• Dislocation/ligament injuries
• Dupuytren's contracture
• Fractures
• Ganglion cysts
• Joint abnormalities secondary to arthritis
• Joint sprains/strains
• Lymphedema
• Nerve injuries
• Occupation-related hand problems
• Overuse syndromes and repetitive strain injuries
• Reflex sympathetic dystrophy
• Rheumatic/arthritic changes to the structures in the hand
• Scars
• Tendon injuries
• Tennis elbow
• Tumors
• Wound and post-surgery infections

Procedures Performed

Closed reduction and fixation
This technique attempts to realign fractured bone, then immobilizing the area during the healing phase with internal fixtures such as wires, rods, splints and casts.

Complex upper extremity reconstruction
Generally performed following spinal cord injury, brachial plexus injury or stroke.

Fabrication of custom splints
For treating congenital anomalies, nerve injuries, palsy, osteoarthritis and rheumatoid arthritis, fractures and tendon injuries.

Fasciotomy
The primary treatment for the early stage of compartment syndrome, this procedure involves the placement of surgical incisions to release pressure and remove any damaged tissue, thereby preventing any additional decrease in function of the affected area.

Joint replacement
Known as arthroplasty, this method relies on artificial joints made out of metal, plastic, silicone rubber or the patient's own tissue.

Peripheral nerve repair and reconstruction
Damaged nerves can often be treated with microsurgical suture repair.

Reconstruction of missing digits
Toe-to-thumb or toe-to-finger transfers are the most common methods of restoring missing digits.

Replantation and revascularization
Depending on the severity of the amputation, more than one surgery may be required for optimal recovery of the reattached region.

Skin flaps
Similar to skin grafting except that the retrieved skin includes the underlying blood vessels, fat and muscles.

Skin grafts
Involves the transfer of a patch of healthy skin from one area of the patient's body to the affected area.

Surgical drainage or debridement of infections
If there is an abscess in the hand, surgical drainage assists in removing the collection of pus. Debridement, or cleansing of a wound to prevent further infection and to help promote healing, may be used if the infection or wound is severe.

Tendon repair
Primary repair of an acutely injured tendon is usually done within 24 hours of the traumatic event while delayed primary repair is typically performed a few days afterwards. Both procedures involve direct surgical correction of the injury. Secondary repairs may occur two to five weeks or longer after the injury and generally rely on inserting tendons from other areas of the body in place of the damaged tendon or other more complex procedures.

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