Hand and Limb Repair and Reconstruction

Injuries to the hand, wrist and limbs are common, often occurring after trauma, work-related injuries and sports injuries. Injuries involving extremities often require surgical reconstruction of the affected area to restore form and function. Reconstruction may also be needed after cancer surgery.

Comprehensive hand and extremity care begins with evaluation by a specialized surgeon. One of our physicians will examine you and coordinate appropriate diagnostic testing.

Some injuries can be treated without surgery. Steroid injections, splints or specialized hand therapy may suffice. But if your injury is more complex, or if you’ve tried other treatments and they haven’t resolved the problem, your doctor may recommend surgery, and possibly physical therapy as well.

At Robert Wood Johnson University Hospital, we offer a range of surgical options to:

• Restore hand and limb function, including stability, sensation, motion and blood flow
• Obtain soft tissue coverage when vital structures are exposed
• Maintain an aesthetically pleasing appearance

Procedures We Perform

The most common techniques we perform include:

• Bone stabilization. While some broken bones or dislocations in the hand and wrist can be treated with a splint or cast, other injuries are better treated with surgery. When surgery is required, the bones are held in place using pins, screws, plates, or wires. Often a combination of surgery and immobilization is necessary.
• Tendon surgery. When tendons in the upper extremity are injured, the ability to move the fingers and/or wrist can be affected. Tendon injuries typically require repair in a timely fashion, although this may vary depending on the nature of the injury. Patients typically require hand therapy following these procedures.
• Tendonitis surgery. Tendonitis in the hand and wrist is common in the general population and can result in pain or difficulty using the hand during daily activities. Tendonitis can sometimes be treated with medication, steroid injection, or other therapies. If tendonitis persists, it can often be addressed surgically to relieve pressure on the tendon. Common examples of tendonitis include trigger finger and DeQuervain’s tendonitis (aka mother’s thumb).
• Peripheral Nerve Surgery. Nerves can become injured from compression or trauma. A common example of nerve compression is carpal tunnel syndrome, which causes numbness or burning in the fingers. Peripheral nerve compression can often be treated by surgically releasing pressure points to the nerve. Nerves injured during trauma can also be repaired using microsurgical techniques to help restore sensation and strength. In some circumstances, nerve transfer surgery can be performed to borrow a functioning nerve that is not needed and transfer it to a nerve that is not functioning properly.
• Ligament surgery. Joints in the hand or wrist can become unstable due to a ligament injury. Ligament injuries commonly occur after dislocations. Ligament reconstruction can be performed to help restore stability and function to the hand.
• Arthritis surgery.Arthritis in the hand and wrist is a common problem in the general population, especially at the base of the thumb. Although arthritis cannot be reversed, the affected joint can sometimes be treated surgically to slow the progression and to decrease pain.
• Dupuytren’s surgery. Dupuytren’s contracture is a common problem caused by soft tissue thickening in the hand and fingers, causing stiffness and difficulty moving the affected fingers. This can sometimes be treated with surgical excision of the thickened tissue.
• Mass or cyst removal. Masses in the hand, wrist, or forearm are often removed to confirm diagnosis and to improve symptoms such as pain. Ganglion cysts are a common example, usually occurring in the wrist.
• Soft tissue coverage. Wounds in the extremities can result from trauma, vascular disease, cancer surgery, or other processes. Reconstructive surgery can be performed to provide coverage over wounds, especially those with important structures exposed, such as nerves, tendons, or bone. Skin grafts are sometimes performed, borrowing skin from another area of the body. For more complex wounds, a flap surgery may be required. A flap is an area of living tissue that is transferred from another part of the body to cover the defect; this can include skin, fat, muscle or bone. This sometimes requires microsurgical techniques.
• Correction of congenital anomalies. Sometimes children are born with hand abnormalities, such as finger webbing (also called syndactyly) or presence of extra digits (polydactyly). Such abnormalities are often addressed surgically to improve function and appearance.

• Limb salvage surgery. In severe limb injuries, limb salvage procedures can sometimes be performed to prevent amputation. This includes repair of blood vessels and/or nerves, reconstruction to cover the open wound, and sometimes limb reattachment.