Cosmetic Hand Surgery
In the mid-20th century, probably no field of reconstructive surgery has attracted more attention and produced more ingenious methods and promising results than the surgery of the hand, which commands the interest of a sizable group of hand surgeons. The economic implications of an injured hand in a society demanding high skills are self-evident.
Among the earliest techniques practiced by the hand surgeon is the restoration of the function of opposition of the thumb to the several fingers. Median nerve injury leaves paralyzed muscles and a hand without pinch and with a weak grasp. By utilizing the tendon of a normally innervated muscle on the opposite side of the wrist and by carrying this tendon to the base of the thumb, it is possible to reestablish the rotation of the thumb across the palm toward the fingers. Among other developments in hand surgery are the use of flexor muscles as extensors when the radial nerve that controls extension of the wrist and fingers has been paralyzed, the restoration of a grasping function in a hand from which all five digits have been amputated or destroyed, the opening of webs in congenitally webbed fingers, the use of the finger for a thumb missing because of injury or maldevelopment, the grafting of nerves in the forearm or hand to restore sensation in the tips of the fingers, and, in the patient suffering from Hansen's disease (leprosy), the use of muscles and tendons from the forearm to replace those made functionless in the hand. In all these procedures relearning is necessary to coordinate in the patient's mind the newly acquired function of the transplanted nerve or muscle. In the well-motivated patient relearning is achieved easily, and quickly becomes a natural part of his thinking.
Not infrequently the transfer of better skin to the hand is a necessary preliminary to reconstructive surgery. The hand may be attached to the abdominal wall for approximately 21 days, or the fingers. may be attached to the opposite forearm or upper arm. When flaps of skin transplanted in this way are used to replace the scar tissue of a deeply penetrating wound, there is striking improvement in the general condition of the hand. Circulation is better, the fixation of the moving structures by scar decreases, and the condition of the skin improves. Occasionally, additional operations are unnecessary.
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