Surgery on the hand and tendons, what kind of anesthesia is used

Preparing for surgery

Before the planned intervention, the patient goes through a preliminary stage:

He is examined, that is, he undergoes tests, does an ECG and fluorography. During preparation, X-rays, MRI and CT scans of the hand, vascular Dopplerography, ultrasonography, arthroscopy, and electromyography are also needed.

X-ray of the hands with rheumatoid arthritis. In the picture: periarticular osteoporosis, multiple cysts, narrowed joint spaces, erosion of articular surfaces.

You should stop taking blood thinning medications 2 weeks before surgery. It is necessary to get rid of any infection and approach the intervention in good physical shape.
At the same time, you need to give up alcohol and smoking. The hands and fingers are equipped with a large number of blood vessels and nerves. Bad habits can interfere with the healing of moving tissues.

Recovery

Therapeutic exercises

Rehabilitation of a broken thumb or other phalanx begins after the fixator is removed. Prolonged immobilization provokes muscle atrophy, therefore, to develop the joint, it is important to perform the following exercises:

clenching the phalanges into a fist,
drum your fingers on a hard surface, imitating playing the piano,
pulling the wrist to the tip of the finger (“Caterpillar movement”),
flexion-extension of the distal phalanx, helping with the healthy hand,
kneading plasticine or dough with a brush,
spreading and closing the fingers.

Physiotherapy

Rehabilitation after a broken finger includes the following procedures:

UHF therapy,
magnetic therapy,
electrical stimulation method,
electrophoresis,
laser therapy,
ultraviolet irradiation,
exposure to ultrasound,
diadynamic current treatment,
warming wraps with paraffin or ozokerite.

The effects of methods on broken fingers are as follows:

restore the mobility of the phalanges,
promotes the production of joint fluid,
accelerate tissue and cartilage regeneration,
relieve symptoms of inflammation and swelling,
saturate tissues with oxygen,
improve metabolic processes in the joint,
strengthen muscles.

Maintaining hygiene

Marginal fractures of the nail phalanx and other joints of the finger require prolonged wearing of a cast. During this period, there is almost no contact of the skin with air, which is why the upper layers of the epidermis peel off. The space between the fingers requires special attention. After removing the fixative, it is recommended to take baths with medicinal herbs that soothe the skin. After the procedure, you should carefully remove dead particles of the epidermis and apply baby cream. It is recommended to treat the interdigital space with antifungal agents.

Traditional methods

You can treat and restore a finger after a fracture with a compress from comfrey root, which is prepared according to the following recipe:

Take 5 tbsp. l. crushed plant roots.
Pour in hot water so that it slightly covers the raw material.
Apply the product to the broken phalanx, bandage and wear for several hours.

If the finger is broken and hurts, a 10-day course of treatment from ivy bud is recommended, the recipe for which is as follows:

Child's finger fracture

Take 60 g of herb and pour 1 liter of water.
Place over medium heat and simmer in a water bath for 15 minutes.
Remove from heat, cool and filter.
Soak gauze in the resulting broth and apply for several hours.

Ways to solve the problem

The type of operation depends on the pathology, its characteristics and many other factors. The doctor will choose a method to obtain the maximum aesthetic effect and restore the functions of the hand and fingers.

For stenosing tenosynovitis

Intervention for stenosing tendovaginitis is carried out under local or general anesthesia, it depends on the scale of the problem. The surgeon performs the following actions:

after antiseptic treatment of the skin, an incision is made along the transverse fold of the palm;
cuts the altered ligament or removes its central section, freeing the thickened tendon;
if necessary, excises its abnormally enlarged part;
the wound is sutured and a bandage is applied.

After this, the tendon is able to move freely, which leads to straightening of the finger.

For arthritis

You can return your fingers to their former appearance and mobility to their joints with rheumatoid arthritis using endoprosthetics:

Finger joint endoprosthesis
provides access to the articular capsule through an incision on the dorsal-lateral surface of the hand;
after opening it, part of the head of the bones is removed;
An implant is placed into the expanded space.

In earlier stages of the disease, surgery only involves excision of abnormal tissue from the joints or around the tendon.

With Dupuytren's contracture

Cicatricial changes in the fascia, depending on the stage of development of the disease, require:

Aponeurotomy . In this case, the contracture is cut, as a result of which the tendons are released and the palm straightens. The operation can be done with a needle or openly.
Aponeurectomy . With it, tendons are released using methods of total or partial removal of scar tissue.

With syndactyly

Surgery to separate fused fingers is done in childhood. During the intervention, a wave-shaped incision is made, and then the wound is stitched or closed with a skin flap taken from other parts of the body. The complexity of the operation is determined by the characteristics of the tissue. If bone or tendon-muscle plastic surgery is needed, it is carried out in several stages.

With polydactyly

The excess segment is removed during an operation, which has features depending on the structure of the process. It is excised:

without affecting the main finger;
with his osteotomy;
with skin, tendon and bone grafting.

The first option of intervention is more often indicated, since the abnormal area is usually devoid of bone.

Fracture of the nail phalanx of the big toe: how long does it take to heal and is plaster needed?

In the absence of a finger or its segment

Reconstructive surgery is performed using an implant or a toe transplanted from the foot. Moreover, in the second case, it is possible to combine amputation and transplantation in one intervention. Over time, the transplanted finger not only becomes similar to its “native” ones, but also functions normally.

Hand surgeries

Temporarily, due to the epidemiological situation, the Novosibirsk Regional Clinical Hospital and the Department of Plastic and Reconstructive Surgery, among other things, provide specialized emergency care to the population of the city and region.

In this regard, the doctor conducts consultations, plastic surgeries, and hand surgeries at the Golden Section clinic.

Address: Gorsky microdistrict, 6 Sign up for consultations by phone: +7383-308-08-08

+7951-386-40-74

The patient is 52 years old, before and 1 month after aponeurectomy—complete excision of the palmar aponeurosis.

A 78-year-old man, before and 1.5 months after minimally invasive (needle) aponeurotomy.

Stenosing ligamentitis (trigger finger)

The patient is 77 years old. Stenosing ligamentitis (trigger finger). The ligament was dissected and the full course of the tendon was restored.

Removal of benign soft tissue tumors of the hand

The patient is 39 years old. Gigantoma of the proximal phalanx of the 3rd finger of the right hand. An excision was performed to isolate the vessels and nerves from the tumor, the result was after 3 weeks, including cosmetic results. The patient is 64 years old. Gigantoma of the left hand. Excision was performed to isolate the vessels and nerves (common digital artery and nerve of 2-3, 3-4 fingers).

The patient is 56 years old. Lipoma of the hand in the projection of the palmar-digital fold. A vascular-nerve bundle passed through the formation on both sides. Isolation of formation using a microscope.

The patient is 60 years old. Lipoma of the hand in the projection of the muscles of the eminence of the thumb. On MRI, the formation is visible as a white oval. A vascular-nerve bundle in the form of a common digital nerve and artery passed through the formation. Isolation of formation using a microscope.

Removal of benign hand bone tumors

Control x-ray after 2 months

The patient is 38 years old. Enchondroma of the proximal phalanx of the 4th finger of the left hand. The tumor was removed and the defect was replaced with an autograft (bone tissue transfer) from the iliac wing. Result after 2 months, including cosmetic results. A 54-year-old female patient complains of numbness in the thumb, index and middle fingers. The carpal ligament was dissected. The nerve is freed. The patient is 67 years old. Productive synovitis of the extensors of the 1st finger. A synovectomy was performed and the extensor tendons were released.

The patient is 18 years old. Comminuted fracture of the 3rd metacarpal bone of the right hand, synthesis with wires.

The patient is 37 years old. Fracture with displacement in the projection of the proximal interphalangeal joint. Correction of deformity and bone synthesis were performed.

Reconstruction of lost parts

Two weeks after surgery

Two months after surgery

Patient 42 years old. Frostbite of the hands with amputation of the fingers. Reconstruction of 1 finger using a rotational radial flap with a bone fragment of the radius.

X-ray 1 year after surgery

Patient 20 years old. Fracture with rotational displacement of the proximal phalanx of the 5th finger of the right hand. Due to the high risk of nonunion of the proximal phalanx, it was decided to perform derotational osteotomy of the 4th metacarpal bone and bone synthesis. Result after 1 year, complete consolidation, elimination of displacement.

The patient is 27 years old. Knife wound at the border of the middle and proximal third of the forearm with damage to the long extensor of the 1st finger. 2 months since the injury. Due to the impossibility of restoring the extensor, the short extensor radialis of the hand was transferred to the position of the long extensor of the 1st finger. Result after 2 months.

Reconstruction of the 4th metacarpal bone

The patient is 17 years old. Hypoplasia of the 4th metacarpal bone of the right hand. Osteotomy, distraction, and reconstruction of the 4th metacarpal bone were performed using an autograft from the iliac wing. Result after 2 years. .

The patient is 38 years old. Radial nerve defect at the shoulder level more than 10 cm, period after injury more than 3 months. To restore the function of extension of the fingers and hand, the ulnar and radial extensors of the hand were transferred to the extensors of the hand and fingers. Result after 2 months.

Treatment of the consequences of burns on the hand

The patient is 39 years old. Post-burn extension contracture of the left hand. Contracture elimination, plastic surgery with full-thickness skin grafts, and lipofilling of scars were performed. Result after 4 months.

Patient 3 years old, contact electrical burn of 3 B degree, flexor and extensor tendons are involved. There was a question about saving the finger. The first stage was an operation to suture the finger to the feeding pedicle on the abdomen. After 17 days, the cutoff was made. Subsequently, the child underwent flap correction and excision of scar deformity.

The patient is 18 years old. Burn of the forearm and area of the hand (wrist) joint. The finger flexor tendons and median nerve are exposed. Plastic surgery of the soft tissue defect was performed using an inguinal flap.

The patient is 41 years old. Post-traumatic contracture of the proximal interphalangeal joint of the 4th finger of the left hand. Ligamentocapsulotomy and arthrolysis were performed.

The result is immediately on the operating table

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Prices for hand surgery

The price includes: anesthesia care, 1 day of hospital stay, observation.

Excision of hygroma under local anesthesia

The price includes: anesthesia care, 1 day of hospital stay, observation.

Excision of hygroma under intravenous anesthesia

The price includes: anesthesia care, 1 day of hospital stay, observation.

Isolation of a nerve in the carpal tunnel (tunnel syndromes)

The price includes: anesthesia care, 1 day of hospital stay, observation.

Tendon repair (1 finger)

The price includes: anesthesia care, 1 day of hospital stay, observation.

Surgical treatment of stenosing ligamentitis (trigger finger)

Reconstructive interventions with microsurgical techniques

from 90,000 to 300,000 rub.

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Types of fractures

A fracture of the little finger is the most common type, since it is the thinnest and is located on the edge of the hand.

A fracture of the thumb occurs less frequently, but this is the most dangerous type, since the process of restoring working capacity is very complicated. This injury is usually accompanied by a dislocation and occurs due to too much reverse extension.

If the ring finger on your hand has suffered from a fracture, you should carefully approach the course of recovery, since its injury can lead to problems in the functionality of the entire hand. Fractures of the middle finger and fractures of the index finger are less dangerous, but if they do not heal properly, they lead to impaired motor skills and other complications.

A marginal fracture of the fingertip often occurs due to negligence when working with tools or heavy weights.

Subperiosteal fracture is classified as a separate type. It usually occurs in children, while the periosteum remains intact, because at this age it is still quite soft and flexible. It is difficult to detect, but it heals quickly and does not require reposition.

With offset

Fractures are divided into two groups depending on how the fragments are located: with displacement, without displacement. A displaced finger fracture can be with divergence or overlap of fragments.

How long does it take for a Finger Fracture to heal, How to speed it up

Based on the number of fragments, they are divided into: non-fragmented, single-, double- and multi-fragmented. Based on the shape of the fault line, transverse, helical, oblique, T-shaped, S-shaped and other types of damage are distinguished. According to location, there are periarticular, intra-articular and extra-articular or fractures of the diaphyseal part.

A displaced injury can take 3 to 6 weeks to heal. It’s easier to say how long it takes for a fracture to heal without displacement; in the absence of complications, it takes 2-3 weeks; it recovers completely in a month.

Closed

A closed fracture is an internal injury in which the integrity of the skin is not compromised. This type of injury is less traumatic and does not threaten infection.

Open

An open fracture is an injury in which the skin is broken and the bone is often visible. The victim may experience bleeding of varying degrees. Dangerous due to the possibility of infection and serious injury to nerves, blood vessels, ligaments, etc.

Phalanx

Most often, individual phalanges of the finger are affected by fractures. Fractures are distinguished:

proximal phalanx,
middle phalanx,
distal phalanx (first).

Injury to the main phalanx is more common than others. A fracture of the nail phalanx often occurs due to carelessness when working with a hammer or other tools. Trauma to the upper phalanx is characterized by massive bone fragmentation and skin damage, which can lead to infection. Interesting to read about the fracture of the hand.

Reconstructive surgery

If a patient is completely or partially missing a phalanx or finger, he will need reconstructive surgery. This can be either a congenital defect or the result of an injury.

The absence of a finger not only greatly reduces the functionality of the hand, but also significantly spoils its aesthetics. Fortunately, today the finger can be restored completely or partially. If it was accidentally cut off or cut off, it can be sewn back on

, and if you need to restore a missing finger, then it is possible to
transplant it from
the patient’s foot.

Vascular surgery today makes it possible to quickly engraft a finger with full restoration of functionality and sensitivity, while minimizing the likelihood of developing any complications.

To perform an operation, a very highly qualified surgeon and high-tech equipment are required. Fortunately, today all this is quite accessible, and such an operation can be carried out in almost any regional center. In some places, laser technology is even used, which greatly speeds up the healing of the finger and helps minimize blood loss.

Contraindications to reconstructive surgery of fingers

Oncological diseases, especially in the area of the hands
Cardiovascular failure
Serious disorders of the liver and kidneys
Tendency to form blood clots
Poor blood clotting
Severe neurological illnesses
Infections and viruses in the active stage
Diabetes mellitus or severe hypertension

Recovery and care after finger correction

Upon completion of any type of operation, a rehabilitation period begins. Its duration is determined by the scale of changes. There are several common points in recovery:

the hand must be fixed in a certain position and not be able to move;
It is important to maintain sterility, that is, treatment of sutures, regular dressings;
when the first healing period has passed, physiotherapy is necessary, that is, massage, electrical procedure, phonophoresis, applications, special exercises;
During the entire recovery period, you should give up bad habits.

After minimal interventions, rehabilitation usually lasts up to 3 weeks. A finger transplant requires several months to recover.

We recommend reading about hand mesotherapy. You will learn about the features and advantages of this procedure, the necessary examinations before the manipulation, the mesotherapy technique, and the results after. And here is more information about the procedure for restoring youth to hands - biorevitalization.

Causes

An extensor tendon rupture is a more common tendon injury than others. The extensors of the fingers have weak fixation to the bone, and the thickness of the tendons is small.

There are two main mechanisms of damage and one additional:

strong axial load on the finger (playing with the ball);
blow to the rear (when the tendon gets hit);
cut and lacerated wounds (the cut line passes through the tendon).

A feature of cut tendon injuries is that the cut may be shallow (the tendon is located just under the thin skin). It happens in everyday life when people prepare food or chop something.

IMPORTANT! The risk of getting an extensor tear increases sharply during physical activity without first warming up the hands and fingers.

Rehabilitation and complications

The duration of the recovery period directly depends on the complexity of the operation performed. For skin transplantation and elimination of minor defects, it lasts no more than 2-3 weeks, and after finger transplantation – up to several months. At this time, it is very important to strictly follow all doctor’s instructions in order to avoid possible complications, the most common of which are:

wound infection;
poor healing;
formation of blood clots and hematomas;
loss of finger sensation;
limited mobility;
rejection of transplanted tissues;
suture dehiscence, bleeding;
formation of keloid scars.

After some operations, temporary immobilization of the entire hand or operated finger is required. The duration of fixation is determined individually in each specific case. Then, to speed up the complete restoration of the functions of the hand and fingers, the surgeon prescribes a course of rehabilitation procedures, which usually includes massage, electrotherapy, and special gymnastics.

Most often, after a successful operation, minor scars remain, which are noticeable only at close range, which can be easily seen by looking at the photos before and after the procedure.

The functionality of the hand is almost completely restored. Reviews and results clearly indicate that much depends on the experience and qualifications of the surgeon. Therefore, before you trust a specialist, you need to try to collect more information about him and make sure he has diplomas and the necessary certificates.

Contour plastic surgery of hands

Sometimes the patient is not worried about the limited functionality of the hands, but only about the appearance. Of all the problems, this one has the easiest solution - contouring. The method involves introducing hyaluronic acid into the skin. The specialist makes injections, injecting filler evenly over the entire area of the hands - from their outer side to the fingers.

After the procedure, the tendons and veins stop protruding through the skin, and the hands do not look bony and dry. Their surface becomes smooth, wrinkles and age-related hyperpigmentation disappear. The method is also used to prevent pronounced aging of the hands. The effect lasts up to 8 - 12 months. Then the injected drug is absorbed, and a new procedure needs to be done.

We recommend reading about hand plastic surgery. You will learn about surgical methods for treating arthritis, stenosing tenosynovitis, Dupuytren's contracture, syndactyly, polydactyly, and more. And here is more information about the surgical treatment of syndactyly.

Types of finger plastic surgery

The human hand is a complex multi-functional tool that we do not appreciate and practically do not notice as long as it works properly.

But as soon as the hand or even one of the fingers is damaged for any reason, the person begins to experience a lot of inconvenience. Especially if the loss of functionality is protracted.

In this case, modern plastic surgery comes to the rescue, which sometimes works real miracles.

Finger defects

Finger plastic surgery can help solve very serious problems that are congenital or acquired. Patients suffering from the following diseases most often seek help:

carpal tunnel syndrome;
stenosing tenosynovitis;
rheumatoid arthritis;
Dupuytren's contracture;
congenital deformities.

With carpal tunnel syndrome, which most often occurs from prolonged overexertion of the hand (continuous writing or constant work on the computer), as a result of nerve compression, numbness of the fingers occurs, pain, tingling appears, and mobility of the hand is impaired. If outpatient treatment does not help, the surgeon makes a longitudinal incision through the hand to the wrist and relieves pressure on the nerve. Local anesthesia is used, the suture heals quickly, and relief occurs immediately after the operation.

Stenosing tenosynovitis manifests itself as impaired mobility of the fingers as a result of inflammation of the tendons. The resulting swelling interferes with the smooth sliding of the tendon along the canal covered with the synovial membrane.

The finger can hardly straighten, making a sharp click, and in severe cases it does not straighten at all. By making a small incision under local anesthesia, the surgeon releases the tendon and restores mobility to the finger.

Rheumatoid arthritis is a serious autoimmune disease, the etiology of which is not fully understood. The body attacks its own joints, causing chronic inflammatory processes in them. As a result, blood circulation is disrupted, sharp pain appears, the joints themselves are deformed, and their mobility is severely limited.

The operation cannot cure the disease, but can only alleviate the suffering of the patient by returning lost mobility to the joints. Some of the swollen tissue is removed and the damaged tendons are reconnected.

Dupuytren's contracture is also incurable and is a hereditary disease. It manifests itself in thickening of the subcutaneous tissues of the palm, causing them to contract. As a result, the fingers end up in a crooked position without the ability to straighten them.

To solve the problem, the surgeon excises the damaged tissue, if necessary, replacing it with a pre-prepared flap of skin taken from the patient's body. The operation is long and requires high precision, so it is performed under general anesthesia.

If the outcome is successful, the mobility of the fingers is almost completely restored.

Congenital deformities can be caused by both genetic disorders and the use of various medications or toxic drugs during pregnancy. These include:

membranes between fingers;
fusion of two or more fingers;
absence of fingers or phalanges;
polydactyly (extra fingers).

Surgeries to eliminate such defects are usually performed in infancy, when the cartilage tissue is soft and easy to correct. In the future, with normal development of the child, the marks will be almost invisible, and the brush will retain 100% functionality. The form of anesthesia and the rehabilitation period depend only on the complexity of the operation.

Recovery and rehabilitation

How long a finger fracture takes to heal depends on its type. This may take from three to ten weeks.

After a broken finger, you need to wear a cast for 2 to 6 weeks, depending on its type.

When the bones heal, the braces are removed, and the person must undergo rehabilitation to fully restore the functionality of the hand. For this purpose they prescribe:

therapeutic gymnastics exercises,
massage,
physiotherapy.

Also today, special fixators - orthoses - are widely used. They are comfortable, but it is important to ensure that the orthosis fits perfectly.

Physiotherapy

Full recovery after a fracture takes quite a long time. To speed up the process, you can perform special exercises:

Before starting work, rub your hands vigorously to improve blood flow,
rotate the brush in both directions,
perform exercises aimed at developing fine motor skills (typing, sorting cereals, putting together puzzles, etc.),
Exercises with an expander allow you to quickly develop your finger muscles.

It is also useful to read about wrist fractures.

Reducing the length of the toes

There are several techniques that allow you to reduce the length of your toes and adjust their shape towards the anatomical one. The choice of technique should be carried out by the doctor, since it depends on the reason that caused the elongation of the fingers.

Osteotomy of the metatarsal bone . Done if the patient has an abnormally long metatarsal bone
Osteotomy of the phalanx . Done if only one phalanx of the finger is long
Osteotomy of both metatarsal and phalanx . It is done if the finger is hammer-shaped and a painful corn has developed on it. This most often happens with severe transverse flat feet.
Arthrodesis of the proximal interphalangeal joint . It is performed if the finger has a pronounced hammer-like shape and is difficult to move. This operation is also performed on women who will wear dress shoes a lot.

All of the above operations are quite simple and, as a rule, do not take longer than half an hour. They are done both on an outpatient basis and in a hospital - it depends on the individual characteristics and mood of the patient. Most often, the patient is sent home on the day of surgery.

Toe defects

IMPORTANT: Modern technologies make it possible to perform operations on the feet with minimal intervention, hidden incisions, and without fixation with knitting needles from the outside. Due to this, recovery occurs quickly and painlessly. Since the operations are primarily aesthetic, there are no visible scars left after them.

Anesthesia for foot surgery

Toeplasty is usually performed under local and regional anesthesia . This means that only the foot will be numb, but otherwise the patient will feel and perceive everything. As a rule, this measure is sufficient for high-quality pain relief. If the patient is very nervous, then it is also possible to use general anesthesia or spinal anesthesia, but this is not directly necessary.

Problems solved by plastic surgery of hands and fingers

Surgery may be necessary in the following cases:

With stenosing tenosynovitis
. The pathology leads to the fact that the fingers or one of them are constantly in a bent position. It disrupts not only the appearance, but also the performance of the hand, and also leads to pain and swelling.

For rheumatoid arthritis
. The autoimmune disease occurs with inflammation of the joints. They become deformed, giving the fingers an unattractive appearance, and the soft tissues swell. Pathological changes cause pain in the hands, making it impossible to work with them or hold anything. The disease can bend the fingers, leaving them in an unnatural position.
With Dupuytren's contracture
. The pathology is a thickening of the subcutaneous fascia in the palm area. This causes the hand and fingers to become bent, as the tendons are pulled. In severe stages of the disease, dense areas form under the skin, making it difficult to straighten the palm.

If a finger is missing due to injury or from birth
. Modern surgery is able to restore it from the patient's own tissues or using prostheses.
For congenital anomalies
. Sometimes a child is born with fused fingers. This is called syndactyly. More often it affects the area of the middle and ring fingers; they are sometimes connected not only by skin and soft tissues, but also by bone. Polydactyly, or the presence of an extra finger, is less common. It is usually composed of soft tissue, sometimes bone is present, but there are no joints.

These defects are operated on in childhood, which allows solving the problem with maximum return of hand function.

The cosmetic procedure of hand biorevitalization will restore beauty to the skin. What medications are used for it? How is hyaluronic acid applied? What are the contraindications?

Some women avoid wearing open shoes because of what they consider to be bad toes. Aesthetic surgery can help them. The operation will make the fingers more graceful, eliminate defects, and the foot will become more proportionate after the operation.

Read in this article

Clinical picture

Symptoms of a tendon rupture are directly related to the location of the injury. With a subcutaneous rupture of the extensor tendon in the nail phalanx, passive flexion of the terminal digital phalanx occurs. The finger looks like a hammer - “hammer deformity”. Active extension movement without assistance in the damaged finger is impossible, but passive extension is maintained.

IMPORTANT! In the first hours, pain and swelling may be absent, only deformation occurs.

If the rupture occurs in the area of the middle digital phalanx , a typical picture arises: the terminal phalanx is in maximum extension, and the middle phalanx, on the contrary, is maximally bent. There is also such a feature - the more a person tries to straighten the finger, the more the deformation increases.

The phenomenon of two-stage flexion occurs because at the moment of rupture, the extensor tendon of the middle phalanx is displaced from its physiological bed, and the lateral tendons take its place. The joint located between the terminal and middle phalanx is located between the tendons. And an attempt to straighten the finger affects only the terminal phalanx, the extension movement of which causes flexion in other parts of the finger. In practice, this manifestation is called the “button loop” symptom or the “boutonniere” symptom. In the medical literature, such damage is described as Weinstein's double contracture.

A typical deformity occurs with a simultaneous loss of active extension function. Pain and swelling may be minor; as a rule, the patient does not even always pay attention to the injury.

Exceptions are cases when the extensor tendon of the finger is torn off with damage to bone fragments. Then severe pain occurs, swelling increases, and passive extension can be painful. Treatment for avulsion of the extensor tendon of the finger is surgical in 90% of cases.

Hammertoe deformity Weinstein deformity

Technique and timing of operations on the tendons of the fingers

The most common types of operations on the tendons of the hand are:

Suture;
Tenolysis - dissection of adhesions;
Tenodesis - fixation of the tendon to the bone;
Moving to another bed from a healed one;
Transplantation.

Surgery for a ruptured tendon of the hand consists of applying a suture, and the sooner this is done, the higher the chances of successful rehabilitation. Proper primary surgical debridement greatly facilitates suture placement and fiber fusion.

An important rule that the surgeon must follow when suturing tendons is to make as few longitudinal cuts as possible, which further injure the already damaged hand.

Rules for suturing injuries to the digital flexor tendon:

The end of the tendon closest to the wrist is isolated from the soft tissue through a separate transverse incision along the distal palmar crease;
If possible, minimal damage to the osteofibrous canal of the hand is ensured;
For stitching, it is recommended to use thin and strong threads; an additional absorbable suture must be placed on the edges of the torn tendon.

After treating the wound with antiseptics, the surgeon makes the required number of cuts in the transverse direction, removes the ends of the tendon and stitches them in compliance with the rules described above. The tendon suture should be simple from the point of view of surgical technique, the ends of the tendon being sutured should not be twisted, and there should be no gap left between them, in which a scar will subsequently grow. The nodes are immersed inside the tendon, preventing it from disintegrating, and the main suture is located intra-trunk.

types of tendon suture

Today, more than 70 types of tendon sutures are used, but the ideal option has not been found, and disadvantages are inherent in each type of suture. The most common is the so-called spiral, the only drawback of which can be considered the need for careful execution. Any technical errors in the spiral suture will lead to serious complications and scarring.

Surgery on the finger is usually performed in a bent position. For deep flexor tendon injuries, the suturing technique depends on the level of injury:

When the tendon is torn off in its farthest part, the end is fixed to the distal phalanx or a stitching thread is passed through the nail and secured there using a special button, which is removed after 4-5 weeks; if fixation is impossible, a tendon suture and an additional wrapping suture are applied to the phalanx;
The most difficult area is from the middle of the middle phalanx to the base of the finger; in case of tendon injuries in this area, it is possible to apply intra-trunk sutures, fix the sutures on the skin on the side of the phalanx using buttons, excision of the superficial tendon in case of a combined injury in order to stitch the deep one and preserve the movement of the finger;
Surgery on the tendon of the hand is indicated for rupture of the tendons in the area from the base of the finger to the wrist; sutures are required on each damaged tendon trunk, and adipose tissue or muscles are used as pads to ensure gliding;
Injury to the tendons at the level of the wrist ligament requires suturing and mandatory excision of the ligament itself so that the inevitable increase in the volume of stitched tissue during healing does not lead to compression and cicatricial fusion of intact tissues, vessels and nerves;
For injuries above the proximal edge of the wrist ligament, the surgeon acts extremely carefully due to the proximity of large vessels and nerves, as well as the difficulty in correctly matching the corresponding ends when several tendon trunks are ruptured at once. The surgeon places a separate intra-trunk suture on each tendon, restoring the integrity of the vessels and nerves, which is extremely labor-intensive and painstaking work.

If it is not possible to suture the tendon due to significant divergence of its edges, plastic surgery using synthetic materials (tendoplasty) or the victim’s own tendons is indicated.

In addition to suturing the tendons and restoring the integrity of other structures during one operation, it is possible to carry out two-stage treatment, which is relevant in the case of massive scar growths on the hand. At the first stage of treatment, the surgeon carefully creates a channel from a synthetic tube, excising scars and suturing blood vessels and nerves. After two months, instead of the tube, a tendon graft taken from the patient himself from another area (leg, for example) is installed.

The use of microsurgical techniques significantly improves the final result of surgery on the tendon of a finger or hand. During the intervention, scars are removed, soft tissue plastic surgery is performed, or missing components are transplanted from other parts of the body.

With a strong adhesive process, tenolysis is indicated - dissection of connective tissue adhesions and isolation of tendon bundles from them. The operation can be performed endoscopically, which gives a good cosmetic result.

How to treat the problem?

Traditional therapy

It is recommended to immobilize broken fingers with the formation of a crack using a fixator - plaster, splint, orthosis. A closed displaced fracture is also treated conservatively if it is possible to set the bone in place. The injury heals in 3-4 weeks. After removing the plaster, it is recommended to apply the following liniments, which relieve swelling and inflammation:

"Indovazin"
"Ibuprofen"
"Nise"
"Lazonil"
heparin ointment,
"Diclofenac"
"Deep Relief".

Surgical intervention

An open fracture of a finger requires repositioning of the fragments, which are strengthened with a medical pin. After the operation, the doctor stitches, bandages the wound with a sterile bandage and fixes it with a plaster cast. For a displaced fracture, you should wear a cast for 1-3 months, the timing is set individually. While wearing the brace, a control x-ray is recommended to check how the fracture of the main phalanx or other bones of the finger is healing.

Indications and contraindications

The main indications for tendon repair are:

ruptures;
injuries;
the presence of adhesions;
contracture (limited range of motion);
diseases of the musculoskeletal system;
paralysis, paresis;
a number of chronic diseases.

The operation is not recommended for scars and inflammation, impaired sensitivity in the operated area, blood diseases, reduced immunity, serious damage to internal organs, diabetes mellitus, acute infection, etc. To identify possible contraindications, a specialist will examine the patient, collect complaints, and also give directions for tests.

Free or paid treatment?

Finger defects and their correction

There are many possible defects of the fingers and hands. And a significant place among them is occupied by serious diseases, both congenital and acquired. The most widespread among them are:

Stenosing tendovaginitis
Rheumatoid arthritis
Dupuytren's contracture
Congenital deformities or simply external defects of the fingers

In different cases, different techniques are used to correct defects.

Stenosing tendovaginitis

This disease manifests itself in the form of impaired finger mobility, which develops due to inflammation of the tendons. Swelling from inflammation prevents the tendons from sliding normally along the canal, and as a result, the fingers either straighten with great difficulty and a clicking sound, or do not straighten at all. In this case, under local anesthesia, a small incision is made on the finger, the tendon is released, and the finger becomes mobile again.

Rheumatoid arthritis

This serious autoimmune disease still has an unknown etiology. In rheumatoid arthritis, the human body itself causes chronic inflammatory processes in its joints, attacking them with its own immune cells. In this case, the joints are deformed, which is why they cannot move normally. This can significantly change the shape of your fingers.

In this case, plastic surgery is performed not to treat the disease, but to restore mobility to the joints. Under anesthesia, the patient has some of the swollen tissue removed and the tendons are then reattached.

Dupuytren's contracture

This incurable hereditary disease causes the patient to thicken the subcutaneous tissues of the human palm. As a result, the tissues contract, and the fingers become curled and cannot be straightened. To solve this problem, the surgeon excises the tissue affected by the disease. If necessary, they are replaced with a flap of skin taken from the patient himself. Because the operation requires extreme precision and takes a long time, it is performed under general anesthesia. This procedure allows you to almost completely restore the mobility of your fingers.

Dupuytren's contracture

Sources used:

https://plasticinform.com/plasticheskaya-hirurgiya/vse-telo/plasticheskaya-hirurgiya-ruk.html
https://xn--h1aeegmc7b.xn--p1ai/zabolevaniya/perelom-sustava-paltsa-ruki
https://irksportmol.ru/travmyi/perelom-paltsa-na-ruke-vidyi-simptomyi-lechenie
https://sustav.med-ru.net/travmiy/razryv-svyazok/metody-lecheniya-r-suhozhilij-razgibatelya-paltsa-ruki-harakteristika-i-posledstviya-povrezhdeniya.html
https://plasticinform.com/plasticheskaya-hirurgiya/vse-telo/plastika-paltsa-kisti.html
https://www.biokrasota.ru/article5564/

Amputation of a finger or fingers: indications, procedure, postoperative period

Amputation of a finger or fingers is a fairly common operation. Hands and fingers have important functions in human life.

But they are very often damaged. It happens that such injuries lead to loss of ability to work and even disability. Treating these injuries is difficult.

If safety precautions and precautions are not followed, the phalanx or finger may be completely torn off. Most often this happens in production.

But there are also transport or household injuries. Traumatic amputation is accompanied by severe blood loss and acute pain.

Types of traumatic amputation:

chopped;
scalped;
when exposed to a power saw;
chopped;
mixed.

When examining the damage, the surgeon always evaluates whether it is possible to save the limb or whether amputation will have to be performed.

The further tactics of medical care will depend on the cause of the injury.

Amputation of a finger is carried out only when it is impossible to apply a more loyal treatment or when the lesion is too extensive.

Cases in which surgery is performed

finger separations, multiple bone fractures;
burns and severe frostbite;
necrosis of fingers in diabetes mellitus;
sepsis, abscess, gangrene;
malignant tumors;
elderly age of the victim.

First aid and storage of an amputated limb

The initial goal when an injury occurs is to save the person's life. You must immediately report the incident to the rescue service.

Check whether the person is breathing and has a heartbeat, and eliminate the cause of the injury. If blood is flowing from the wound, it must be stopped and a bandage applied. The hand must be kept motionless. Give the victim a sweet drink and put him to bed. And only after taking these measures, begin to search for the severed limb.

It happens that amputated fingers are reattached and in the future they are fully functional. It is important to remember that before the amputated limb can be reattached, it must be cooled.

At temperatures up to four degrees, fingers can be stored for 16 hours. If stored at a temperature warmer than four degrees, the time is reduced to 8 hours.

The severed finger must be wrapped in sterile material and placed in a container so that oxygen gets in; it must not be pulled tight. Place the container in ice. Attach a cover note indicating the time of amputation.

If there is a partial amputation of a finger or damage to the tendons, there is no need to completely tear off the hanging element. It needs to be fixed and ice applied.

If amputation occurs, the person becomes disabled, so surgeons try to the last to save the finger. When this cannot be done, surgery is performed with the patient's permission.

Read on the topic - How amputation of the lower extremities is performed. Indications, types, possible complications

Permission is not required only if the operation is vital.

Preparing for surgery

Prepare for surgery based on the patient's condition. During planned operations, blood tests, urine tests, x-rays, and vascular ultrasound are prescribed. When surgery is urgent, antibacterial agents are prescribed to reduce the risk of intoxication.

Generally, local anesthesia is used for such operations; it is safer.

During preparation for finger disarticulation, a conversation is held with the person about the operation itself, the results and consequences.

If necessary, it is recommended to consult a psychologist to reduce stress levels and post-operative depression.

Finger amputation - nuances

The size of the amputation is determined by the nature of the injury. It is necessary to ensure that after the operation the stump can move, is painless, and does not thicken at the end.

When carrying out the operation, the following nuances are taken into account:

During disarticulation, they try to preserve the length of the thumb and little finger as much as possible; even short stumps are preserved on the remaining fingers.
If it is impossible to maintain the required size of the stump, the finger is removed completely.
If there is a high risk of infection or gangrene, complete amputation is performed.
During the amputation period, the person’s profession is taken into account.
The cosmetic result is important, and sometimes it is of primary importance when choosing the type of operation.

Exarticulation technique

Disarticulation is a surgical operation during which part of a limb is removed. It is performed in case of urgent need.

When performing disarticulation:

give anesthesia
healthy fingers are protected as much as possible, and the damaged one is strongly bent and an incision is made on the inside
A vein or artery is ligated
After this, the lateral ligaments are cut and the phalanx is passed through the incision.
An additional painkiller is administered and all other elements are crossed.
The articular cartilage is removed.
A flap of skin is applied to the wound. The seams are always located on the inside. During amputation, tissue is always saved as much as possible; flaps are taken from the skin of the palm.

In the postoperative period, the wound must be properly cared for and hand functions must be trained. Physiotherapy and exercises are prescribed to help the patient learn to work with the stump.

In order for recovery to occur as quickly as possible, you need to follow all recommendations and prescriptions and take analgesics.

Postoperative period

In the first few days after amputation, the patient will need pain medications. Then the inflammation will decrease and the wound will crust over.

After two weeks, the wound no longer hurts, dressings are painless.

If pain persists longer, it is necessary to take an x-ray and extend the course of antibiotics. Sutures are removed 3–4 weeks after surgery.

It is recommended to apply bandages with Betadine ointment before removing the stitches.

Source: https://MedOperacii.com/orto/amputaciya-palcev-ruk.html