Hand Reconstruction

The hand scars badly after a burn or a deep injury, and the scar shortens as it matures. Fingers curl, the web spaces between them close in, the thumb loses its span and the wrist stops extending. Reconstruction releases that tightness and puts healthy, pliable tissue in its place so the hand opens and grips again.

What your surgeon does depends on what has been lost. A tight band is released and resurfaced with a full-thickness skin graft or a local flap. A stiff joint may need its capsule released and a wire to hold the position while it heals. Tendons that are stuck are freed, and tendons that have gone are reconstructed or transferred from elsewhere in the hand.

The operation is one half of the treatment. Splinting and hand therapy afterwards decide how much movement you keep, and that is worth knowing before you start.

You are asleep under a general anaesthetic, or the arm alone is numbed with a block at the shoulder. A tourniquet on the upper arm gives your surgeon a bloodless field.

The contracted bands are cut across, and the finger or thumb is straightened as far as it safely will go. The defect that opens up is then covered, usually with a full-thickness graft taken from the groin or the inner arm, or with a flap turned in from nearby skin. Wires sometimes hold the fingers straight while the graft takes. Most operations take two to four hours.

You wake with the hand bulky in a dressing and a splint, held up on a pillow or in a sling. Grafts are usually first inspected at five days.

One or two nights in hospital is usual. The hand stays elevated for the first week to control swelling, and the splint stays on between exercises for four to six weeks, often at night for three months.

Hand therapy starts within the first two weeks and is the part that matters. Expect two or three sessions a week to begin with, and daily exercises at home. Wires come out at three to four weeks. Light use of the hand comes back at four to six weeks, driving at around six, and manual work at three months.

Strength and full movement improve for six to twelve months. Pressure garments and silicone over the grafts for several months keep the new scars from tightening again.