Hand reconstruction surgery

Hand reconstruction surgery is used to repair the tissues, tendons, muscles, bones, and nerves of the hand or fingers to improve their function and appearance. This specialized surgery is often used to treat a significant injury to the hand or fingers that may involve sudden trauma, like crushing or severing parts of the hand. It may also be used to treat some congenital conditions (present from birth) such as fused fingers.

Penn Medicine is widely recognized for using innovative procedures that help preserve and improve hand and finger function. Our multidisciplinary team of orthopaedic surgeons, microvascular surgeons, hand plastic surgeons, and hand therapists work together to treat even the most complex of hand reconstruction surgeries. Our locations throughout southeastern Pennsylvania and New Jersey provide convenient access to world-class care close to home.

Hand or finger reconstruction surgery requires a combination of precise and delicate procedures to repair tissues, improve appearance, and restore function. Techniques include:

• Microvascular techniques: Microvascular hand reconstruction allows surgeons to restore blood supply and repair nerves to help prevent long-term damage to a hand or finger. Using a special microscope and surgical instruments, microvascular specialists work on tiny blood vessels to repair damaged areas and provide adequate blood flow to support healing.
• Tissue transfer: Sometimes referred to as free-flap surgery, tissue transfer moves skin and other soft tissue from a healthy part of your body (or from a donor) to the reconstructed area to close large wounds. Microvascular surgery is used to reattach blood vessels from the healthy tissue to your hand to support the skin coverage needed.
• Plastic surgery: Reconstructive plastic surgery uses skin tissue transfer and other specialized techniques for the hands and fingers to restore both their function and cosmetic appearance.
• Replantation: This procedure is used when a hand or finger is detached. It focuses on reattaching the hand and finger in its normal position.

Hand or finger reconstruction surgery is often performed after sudden trauma from accidents or falls. It may also be used to correct a congenital abnormality of the hand or fingers.

The most common reasons for hand or finger reconstruction surgery include:

• Mangled or crushed hands or fingers
• Burns
• Detachment of hands or fingers
• Congenital conditions, such as fused, duplicate, or missing fingers

Your doctor will perform a thorough examination and review blood and imaging tests to be sure you are in good health and a likely candidate for successful reconstruction surgery.

While each hand or finger reconstruction surgery is specific to your situation, there are some common processes many people experience during surgery:

• You’ll receive general, regional, or local anesthesia to keep you comfortable and pain-free during the procedure. Your doctor will recommend the best option for you.
• Any dead or damaged tissue will be removed from the area to prepare it for reconstruction.
• Bones may be cut and aligned into their proper position (also known as an osteotomy.)
• Soft tissues, such as tendons or muscles, will be repaired along with blood vessels and nerves, using microsurgical approaches and specialized instruments.
• Skin around the affected area will be repaired using healthy skin taken from another part of your body or from a donor.
• A splint or cast may be applied to keep your hand or fingers in their optimal position for healing.
• You’ll be moved to a recovery area where you’ll be monitored closely. You may be able to go home the same day, though some people may stay in the hospital for a day or two.
• When you’re ready to go home, you’ll receive instructions on how to care for your wounds.
• A surgical follow-up appointment will be scheduled to check your progress, and a member of the orthopaedic team will be available to answer any questions as you begin the healing process.

All surgeries carry some risks. In addition to risks of infection, blood clots, and bleeding, some risks of hand reconstruction include:

• Changes in the sensation of your skin
• Changes in skin color
• Unusual scarring
• Uncommon swelling in the hand
• Damage to soft tissues like nerves, tendons, or muscles
• Persistent pain
• Issues with healing

Your doctor will discuss these risks with you prior to surgery and address your concerns or questions.

Hand reconstruction is a demanding surgical procedure that requires a team of specialists. At Penn Medicine, you’ll find expert orthopedic, microvascular, and plastic surgeons who work together to provide comprehensive, individualized care. With more specialists on your case, along with advanced surgical technology and techniques, you’ll receive exceptional care for your reconstruction surgery—no matter how simple or complex your situation.

When you have hand or finger reconstruction surgery at Penn Medicine, you can expect:

• Innovative orthopaedic procedures: We specialize in delicate and complex hand reconstruction techniques, including finger and hand reattachment and microvascular reconstruction to support the regeneration of healthy tissues.
• Microsurgery expertise: We are the nation’s most experienced center for microsurgery, a highly complex procedure in which surgeons take bone, muscle, and skin from a healthy part of the body to help repair another area.
• Excellence in plastic surgery: Our plastic surgeons are well known and respected around the world for their exceptional skills and innovations in care. You’ll receive care from plastic surgeons who are hand specialists. They have experience in helping patients regain function and can improve the cosmetic appearance of hands and fingers.
• Integrated care for hands and wrists: Our team works with other specialists at Penn Medicine, including the Penn Orthoplastic Limb Salvage Center, the only program of its kind in the nation that provides unique expertise for patients that are at high-risk of limb amputation or in need of functional limb restoration. Our orthopaedic team also provides surgical options for hand and wrist tendon and ligament repair, offering companion treatment options for patients who require additional services.