Reconstructive surgery is performed to restore or rebalance the function of the hand. Surgery also allows the hand and fingers to function as expected in normal positions. This procedure often improves the function of the hand cosmetically, which can improve the patient’s self-image. Finger reconstructive surgery should be performed while the fingers are still supple, as waiting until contractures have become fixed complicates optimum surgical results.
What is Finger Reconstruction?
Reconstructive finger surgery is helpful in restoring function, such as pinch and grip, or other specific movements that a patient needs for work, sports or recreation. Hands that have developed contractures can often be improved by reconstructive surgery. Rehab before and after reconstruction may be required to optimize results.
Who is a Candidate for Finger Reconstruction?
Reconstructive hand surgery can correct or improve a wide range of functional and aesthetic issues affecting the patient’s hand. Finger reconstruction can repair tendon injuries, birth anomalies, and joint deformities caused by rheumatoid arthritis (RA), including:
- Tendon repair. This is a common surgery which involves reconnecting a severed tendon. This improves movement and function in your finger.
- Birth anomaly reconstruction. Finger reconstruction can treat congenital disorders such as webbed fingers (syndactyly). Your surgeon will separate the webbed fingers to provide more motion and better appearance.
- Autoimmune conditions, such as rheumatoid arthritis, can damage the patient’s body, which includes the finger joints. If finger involvement is severe, reconstructive surgery can release or repair abnormal bending of the fingers, or repair or reattach tendons. Surgeons can also remove inflamed tissue (synovium) from the hand and sometimes avoid future damage.
- Bony Defects from trauma and osteomyelitis. Acute osteomyelitis is a serious bone inflammation that can result from previous trauma, a puncture wound, surgery, open fracture, or infection of the soft tissues. Treatment of osteomyelitis depends on the extent of the infection. It might be necessary to drain and clean the infected area surgically and then continue treatment with antibiotic therapy. In some cases reconstructive surgery using a bone graft may be necessary. The Masquelet technique is used in complex finger reconstructions
In some conditions, surgery is necessary to treat wounds and injuries. There are a significant number of factors to consider when determining who would be an appropriate candidate for finer surgery. If you think you need surgery to correct a functional or cosmetic medical issue affecting your hand, please don’t hesitate to reach out to an expert. To determine if finger surgery is right for you, contact Dr. Mark Pruzansky and Dr. Jason Pruzansky.
Types of Reconstructive Surgery for the Finger
Finger surgery is a broad term covering many types of procedures. Surgeons who perform surgery on the hands and fingers seek to restore hand and finger function but also try to achieve the best appearance possible. Because the hand houses many complex structures, it’s important to work with an experienced surgeon qualified to perform these procedures. Hand and finger surgery may be done for a variety of reasons, including:
- Tendon Repair, Grafts, and Transfers. Tendons of the fingers join the muscles to the bones for mobility. Tendon repair can involve primary repair, delayed primary repair, or secondary repair.
- Primary repair is usually a direct surgery to repair an injury and typically occurs within a few days of the initial injury.
- Delayed primary repair is usually done within a few weeks of the injury.
- Secondary repairs tend to occur 2-5 weeks after the injury and may include tendon grafts.
- Microsurgery of the nerves. An injury to the nerves in the hand can cause loss of function or feeling in the hand. While some nerve injuries may heal on their own, others may require surgery, generally within as close in time to the injury as feasible with the assistance of a hand surgeon to make that judgment. If the nerve is cut or severed, it may be repaired by reattaching it to the other end of the nerve.
- Sometimes, a nerve graft may be required. This may involve replacing the short, damaged nerve with a nerve from different donor sites from other areas of the body.
- Skin flaps. Like a skin graft, skin flaps of the hand involve sourcing skin from another part of the body. However, this procedure uses skin with its own blood supply. This section of skin includes underlying blood vessels, and sometimes fat and muscle, and may be used in an area missing skin without a good blood supply. This may be due to the extent of the tissue damage, damage to the vessels, or the location itself.
- Bone grafts. Bone grafting uses transplanted bone to repair and rebuild diseased or damaged bones. During a bone graft, your surgeon will insert a new piece of bone in the affected area. There, the new bone can become incorporated into the adjacent bone. This may be accomplished with an allograft or an autograft.
- Certain injuries may require the Masquelet Procedure. This technique is indicated for the treatment of large segmental bone defects, consisting of a two-step procedure.
- After thorough debridement to achieve a clean cavity, a bone cement spacer is introduced in the bone defect followed by reconstruction of the soft tissue.
- After 6-8 weeks, the spacer is removed and the defect is filled with a bone graft. The bone graft utilized is autologous cancellous pieces or corticocancellous graft when stronger structural support is needed.
Many complex skin, bone, and tendon techniques applied to bone anomalies can be used to correct a wide range of functional and cosmetic issues affecting your finger. Successful outcomes and special expertise are characteristic of our surgeons, Dr. Mark Pruzansky and Dr. Jason Pruzansky.
Recovering from Finger Reconstruction
Once healed, your finger may operate easily, with little to no pain. Recovery from finger reconstruction can take anywhere from 6-8 weeks to several months, depending on the deficit and the procedure. However, healing time is highly dependent on the injury, individual, and many other variables. Many patients with nerve damage and reconstruction report a “pins and needles” sensation in the affected region. Because nerve fibers grow approximately one inch every month after disruption or repair, it can take many months for the nerves and muscle groups to heal following injury and repair.
After receiving guidance from a hand surgeon, patients can rest their fingers by applying P.R.I.C.E principles:
- Protect: the injured area may be protected with a splint, per the doctor’s instructions.
- Rest: the injured finger should be allowed to rest.
- Ice: use a cool pack or ice bag judiciously to reduce swelling and pain.
- Compression: prudently wrapping the area with a bandage usually limits the amount of swelling that can occur, only with the input of a professional.
- Elevate: elevating the finger also helps control swelling by using gravity to reduce fluid accumulation in the affected area.
Please contact us as soon as possible to schedule an appointment with our talented team. People experiencing finger pain from an injury or bone defect should be evaluated to try and prevent further injury and mobility issues.
If you have been injured, it’s important to be evaluated by a highly skilled professional. Call Dr. Mark Pruzansky and Dr. Jason Pruzansky at 212-249-8700 to schedule an appointment and obtain an accurate diagnosis and the best treatment plan.