Hand & Microvascular Surgery

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Hand Surgery

This sub speciality of orthopaedics focusses on treating specific conditions of the hand by surgery.Our hands are one of the most important functional units of our body. If injured, they need to be repaired in such a way that daily activities and if possible, our skills can be resumed. The same is true for the feet, even a small pain or deformity in the foot will make walking painful.

Conditions of the hand

  • For pain in hands: Carpal tunnel release is performed for the median nerve at the wrist and anterior transposition of the ulnar nerve at the elbow.
  • Tendon transfers are performed to rebalance the paralytic hand in order to distribute the forces equally.
  • Clawing in hands is corrected by tendon transfers. Tendon transfers are performed on the thumb to provide the power of opposition to the fingers.
  • Surgical arthrodesis is used to stabilize unstable or diseased joints.
  • Surgical debridement and limited amputations may be required for infections related to wounds on the insensate hand.
  • Skin grafts can surgically release contractures, if needed.
  • Cosmetic procedures are available to improve the overall appearance of the hand, this is very useful to reduce the stigma of Hansen’s disease [Leprosy].

Microvascular Surgery

Microvascular [micro=very small, vascular=relating to blood vessels] Surgeries are intricate surgical techniques to join together tiny blood vessels and helps to transfer large amount of tissues e.g. muscle, bone, tendon or cartilage from distant parts of the body to reconstruct wounds and tissue defects.

Very small blood vessels such as those only 3 to 5 millimetres in diameter are ‘anastomosed’ [connected together] to create a ‘new’ blood supply to tissue which has been transferred from one place in the body to another. For example, in ‘Commando Surgery’ done for cancer of the mouth, large portions of the jaw may be removed. To make the face look nice, muscle, skin and bone tissue are removed from other parts of the body and ‘grafted’ to replace the missing parts of the jaws, cheeks or chin. Microvascular surgery connected the blood vessels of the face to the blood vessels of the grafted parts to ensure that the newly attached parts get blood supply, oxygen and nutrients and they thrive and become a live part of the new area. This is known as reconstructive surgery. The transplanted healthy tissue from a distant site is called a “free flap”. This healthy tissue is moved to the site of the wound where blood circulation is restored.

Microvascular surgery is done through an operating-room microscope using specialized instruments and tiny needles with ultrafine sutures.

Microvascular surgery is also used to reattachsevered fingers, hands, arms, and another amputated parts to the body by reconnecting the small blood vessels and restoring the circulation before the tissue starts to die.

Free flap surgery is complex and technically challenging. It is ideally performed Germanten Hospital, where the procedures are done with a high success rate.

Free flap procedure done at Germanten are:

  • Breast Reconstruction
  • Superior and inferior gluteal flap
  • TFL flap
  • Ruben’s flap
  • Gracilis flap
  • Trunk
  • Abdomen and chest, typically large wounds caused by radiation therapy and cancer surgery
  • Head and Neck Reconstruction
  • Jaw or jawbone (mandible)
  • Oesophagus
  • Scalp
  • Cranial base
  • Legs (Lower Extremities)
  • Traumatic wounds
  • Post-cancer surgery
  • Salvage of amputation stumps
  • Bony reconstruction
  • Non-healing lower extremity ulcers secondary to diabetes
  • Arterial or venous insufficiency
  • Facial Re-Animation Surgery
  • Restoration of facial expression following nerve injury or cancer surgery
  • Hand surgery
  • Wounds where blood vessels have been cut
  • Transplantation of functioning muscle

Germanten hospital handles a large number of road side accident, fractures and trauma cases. Microvascular surgery department is instrumental in supporting every surgery needing restoration of blood supply to tissue. Microvascular surgery is the foundation to success of trauma surgeries in Germanten Hospital.