Soft Tissue Reconstruction of the Hand

What is Soft Tissue Reconstruction of the Hand?

Soft tissue reconstruction of the hand is a surgical procedure to repair or replace damaged soft tissue structures of the hand. Based on the gravity of the soft tissue defects in the hand, flaps and grafts of bone, skin, muscle, or other tissue from a healthy donor or the patient’s own body are often used for reconstruction of the affected structures. Soft tissue reconstruction helps to restore both the function and aesthetic appearance of the hand.

Several types of flaps may be used for reconstruction according to their location in relation to the defect in the hand. These include:

• Local flaps: These flaps are harvested from tissue surrounding the site of injury.
• Regional flaps: These flaps are harvested from a non-injured part of the hand.
• Distant flaps: These flaps are harvested from a distant site away from the injured hand.

Anatomy of the Hand

The hand is considered one of the most complex structures in the human body due to its intricate anatomy. Your hands are a complex system of various bones, joints, ligaments, tendons, muscles, nerves, and blood vessels. Without the healthy functioning of the hand, we are unable to perform activities of daily living. The hand is one part of the body that is very susceptible to injury or disease. The intricate anatomy of the hand requires very delicate surgery, often with microscopic techniques.

Indications for Soft Tissue Reconstruction of the Hand

Soft tissue reconstruction of the hand is recommended for conditions, such as:

• Traumatic injuries: These may include fractures, tendon injuries, digit amputation, or lacerations with nerve or blood vessel damage.
• Arthritis-related deformities: In severe cases of osteoarthritis and rheumatoid arthritis, the joints and fingers have a deformed appearance.
• Overuse injuries: These include carpal tunnel syndrome, trigger finger, and De Quervain’s Synovitis.
• Infections: Hand infections are commonly seen in people with diabetes as they have poor blood circulation in the extremities.
• Congenital deformities: These deformities are present at birth and may include congenital constriction band syndrome, overgrowth of digits, undergrowth of digits, duplication of digits, failure of part of the hand to separate (syndactyly), and underdeveloped fingers or thumbs.

Preparation for Soft Tissue Reconstruction of the Hand

In general, preparation for soft tissue reconstruction of the hand will involve the following steps:

• A review of your medical history and a physical examination is performed to check for any medical issues that need to be addressed prior to surgery.
• Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
• You will be asked if you have allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications or supplements you are taking or any conditions you have such as heart or lung disease.
• You may be asked to stop taking certain medications, such as blood thinners, anti-inflammatories, aspirin, or other supplements for a week or two.
• You should refrain from alcohol and tobacco at least a few days prior to surgery and several weeks after, as it can hinder the healing process.
• You should not consume any solids or liquids at least 8 hours prior to surgery.
• You should arrange for someone to drive you home after surgery.
• A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.

Procedure for Soft Tissue Reconstruction of the Hand

In general, soft tissue reconstruction of the hand will involve the following steps:

• You will lie on the operating table under regional or local anesthesia with your hand held in a specific position.
• Your surgeon cleans the hand with an antiseptic solution and an incision is made to expose the treatment area.
• Necrotic tissue and debris are removed from the site of injury.
• Using magnification technology and special microsurgical instruments, the delicate blood vessels and nerves are repaired.
• The harvested flap is placed on the treatment area appropriately to cover the soft-tissue defect.
• Your surgeon may also carry out other repairs as necessary.
• The overlying soft tissue and skin are closed with sutures, and sterile bandages are applied.
• If the hand injury is very severe, multiple surgeries may be necessary to optimize hand function.

Postoperative Care and Instructions

In general, postoperative care instructions and recovery after soft tissue reconstruction of the hand will involve the following:

• You will be transferred to the recovery area where your nurse will closely observe you for any allergic or anesthetic reactions and monitor your vital signs as you recover.
• You may notice pain, swelling, and discomfort in the hand area. Pain and anti-inflammatory medications are provided as needed to keep you comfortable.
• You are advised to keep your hand elevated as much as possible during the first month to reduce swelling and pain. Your physician may recommend a foam wrist-elevation pillow or other devices.
• Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
• You may start rehabilitation or a physical therapy regimen as recommended by your surgeon after a specified period of time to improve range of motion and strengthen hand muscles.
• Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months from the operated hand. A gradual increase in activities is recommended.
• You will be able to use the treated hand 6 weeks after surgery. However, it may take 6 to 12 months for your arm to regain its full strength.
• You may return to your work in about 6 weeks if your job is not too physically demanding. Those with physically demanding jobs will require a longer recovery period.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Soft tissue reconstruction surgery of the hand is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:  

• Infection
• Bleeding
• Pain and weakness in the hand
• Adverse reactions to anesthesia
• Damage to adjacent soft tissue structures
• Loss of sensation
• Stiffness
• Delayed healing or failure to heal