The definition of an amputation is “the action of surgically cutting off a limb,” however, an amputation can also happen by accident. Many times, an amputation of the hand, finger or arm is the result of a tragic accident, but amputations can also be planned surgeries to prevent the spread of a disease. Sometimes, fingers that were amputated in an accident can be reattached by a hand surgeon, but this isn’t always possible.
Hand surgeon David Friedman, MD, FACS, answers your questions about preparing for an upcoming hand surgery.
1. Will I need medical clearance before surgery? What other tests might I need?
Medical clearance may require a visit to your primary care physician and/or a specialist like a cardiologist or pulmonologist. Whether or not you require medical clearance depends on many factors including your age, medical history, and the type of surgery and anesthesia you are having. You may require blood work, an EKG, and/or a chest X-ray. For some types of surgery and depending upon your age and health status, no pre-operative clearance or testing may be needed.
IT’S LONG BEEN SAID that in addition to a large brain, another critical characteristic that separates us from most other animals is our opposable thumbs. The thumb joint has a wide range of motion that makes pinching and grasping motions possible, and most other animals, save for fellow primates, lack this ability. Thumb joints have been credited with enabling us to make a variety of technologic advancements, but over the course of a life, they sustain a lot of wear and tear. “Dexterity comes at a price,” the Arthritis Foundation reports. That price is “an increased risk of osteoarthritis in the first carpometacarpal joint, where the thumb meets the trapezium bone in the wrist.”
Osteoarthritis is a disease of aging, and it’s very common. The Centers for Disease Control and Prevention reports that osteoarthritis is the most common form of arthritis, affecting more than 30 million adults in America. OA features inflammation of the joint that can impact its mobility and function.
Dr. Ekkehard Bonatz answers your questions about what to expect after you’ve had hand surgery.
Q: I’ve been told I will have a cast, splint, or brace. What does that mean?
A: Many surgeries require a short time of protection to allow your body to start its recovery from your procedure. Leaving surgery, your hand, wrist, or forearm may be wrapped with a bulky dressing. Surgeons will frequently include a splint as a part of the dressing. It is a rigid part of the dressing that is intended to protect the surgical repair and add to comfort. A splint typically covers only part of the surgical area, leaving some room for swelling. Depending on what is needed for your particular surgery, your surgeon may recommend that you return to the office after a few days for a dressing change or a change to a full cast.
A cast is applied by wrapping fiberglass tape or plaster around your hand, wrist, or arm. The cast hardens and forms a rigid hollow tube around your extremity. It holds the surgical area still during the healing process. It may need to be changed over time to account for swelling, wound care, suture removal, or to take x-rays. Some surgeries require a brace during the healing process.
After an injury or surgery, our bodies naturally make scar. Scar tissue can become a problem if it limits function and/or is unpleasant to look at. Scar tissue can be treated. A physical or occupational therapist who specializes in treating upper extremity injuries can help. There are several factors a therapist assesses to determine the best course of action for scar management. These factors may include the following:
- How close the scar is to a tendon or muscle: A scar may become adherent to the surrounding tissue such as tendons and/or muscles. As tissues heal, scar adhesion can make movement more difficult. Therapists prescribe specific and directed movements that can reduce adherent scarring.
- Shape of the scar: If your scar is from a surgery, it is usually a thin line. If scar is from an accident, it may be irregularly shaped and/or vary in depth which could make it unpleasant for you to look at.
- Type of scar: As skin heals, it shrinks slightly and can cause pain and interfere with motion. Hypertrophic scarring can occur causing scar tissue to form outside the normal borders of the wound. Keloid scarring can also occur which causes a large, raised scar.
- Sensitivity of the scar: Skin is used to being touched by different textures during the day such as clothes, jewelry, and resting surfaces. After an injury or surgery, the wound area is covered for a short amount of time to keep it clean and protected. During this time, the skin can become hypersensitive. This can be very painful, cause you to protect your scar during use, and may also affect your sleep.
The hand is extremely unique, and it takes a special type of surgeon to treat it. You may be surprised to learn these three things about hand surgeons:
- Hand surgeons treat everything from general hand pain to hand emergencies. Just because you don’t need hand surgery doesn’t mean you shouldn’t see a hand surgeon! Hand surgeons are specialists for all things related to the hand and can treat a variety of conditions including carpal tunnel, trigger finger, sports injuries, jammed fingers, broken hands/fingers, birth defects, etc. Hand surgeons can also potentially reattach your hand or finger if it is severed in a traumatic incident.
- Hand surgeons don’t just treat hands. Most hand surgeons treat the wrist and arm as well. Many can also treat the elbow and shoulder.
- Hand surgeons receive additional, specialized training. This extra training is a full year on top of their residency.
Surgery generally falls into two categories, elective and emergency. Outcomes from these two types can vary greatly. Emergency surgery is usually done to preserve life or function and usually follows some sort of serious incident or injury. Elective surgery means you may have some choice about the surgery as well as some time to discuss options with your doctor or medical team.
Post-operative expectations following surgery will depend greatly on the type of surgery you have, the amount of damage before and during surgery, your body’s response, and how well you take care of yourself afterward.
How can I prepare myself for my surgery?
The best way to prepare for surgery is to start as early as possible. Most surgeries come with a set of precautions for after surgery, but what you do before surgery can also make a difference.