surgery

Elective procedures

Many different diseases and conditions affect the hand. Surgeons have a vast array of surgical and non-surgical techniques available to alleviate or remove specific problems. At the London Hand and Wrist Unit we see patients having had a plethora of different procedures. If you wish to speak to a member of the London Hand and Wrist Unit for further information, please call 020 7483 5090.

The following are examples of some of the most common elective procedures carried out at the London Hand and Wrist Unit.

Surgery for Carpal Tunnel Syndrome

Surgical release of the carpal tunnel is carried out under either local or general anaesthetic, normally as a day case.

The procedure involves division of the flexor retinaculum (also known as the trans carpal ligament) and occasional debridement of scar tissue or reduction of synovitis that may be found to be compressing the nerve.

Following surgery, the hand is normally placed in a bulky dressing and elevated (to minimise post operative swelling). Normal gentle movement of the fingers and thumb is encouraged, with precautions against heavy use of the hand for up to the first four weeks after surgery. Hand therapy follow up will ensure the wound is monitored and re-dressed, sutures are removed at 10-14 days after surgery, scar management is commenced and normal movement and function is regained through exercise and light functional use.

For further information about Carpal Tunnel Syndrome follow this link:

Carpal Tunnel Syndrome information >

Surgery for Dupuytren's Disease

Surgery involves removal of the taut, retracted palmar fascia from the palm and affected finger(s), known as palmar fasciectomy. This may be performed under general or regional anaesthetic. A zigzag incision is made in the palm and extends into the finger(s). This allows for better healing of the skin and a gain in skin length to further aid in relieving the contracture. Meticulous dissection of the diseased tissue is carried out, with extreme care taken to protect nerves and blood vessels. Usually, the wound is closed with sutures, but on some occasions your surgeon may elect to leave part of the wound open. Occasionally the surgeon may use a skin graft to close the area, usually when there is significant loss of skin (this is normally in very severe cases of contracture).

Following surgery, the hand is elevated (to minimize post operative swelling) and immobilised in a large bulky compressive dressing and usually supported on a Plaster of Paris slab. Your hand therapist will remove this between 2 and 7 days after the operation, in order to manage the wound and commence an exercise programme. A thermoplastic custom made hand splint may also be necessary for up to 6 months (usually at night) to maintain the correction and control length of scar tissue. Therapy can continue for a few weeks or several months to regain joint mobility, soften the scars and restore hand function.

For further information about surgical correction of Dupuytren's disease follow this link:

Dupuytren's disease information >

Surgical management of ganglions.

Aspiration of a ganglion by a hand surgeon may sometimes be used to temporarily or permanently treat the condition. This consists of first numbing the area with a local anesthetic and then inserting a needle to withdraw the clear, jelly-like fluid from the ganglion sac.

The most reliable method of treating a ganglion, however, is by surgical excision. Ganglions in the finger can usually be removed under a local anesthetic while those in the wrist usually require a regional or general anesthetic. The ganglion is removed through an incision directly over the area of swelling. Care is taken to remove the entire sac, and possibly a tiny amount of surrounding tissue, in order to prevent any recurrence.

Following excision of a ganglion, a bulky compressive dressing will be applied. Your therapist will initially teach you how to prevent post operative swelling and some early range of motion exercises to prevent the possibility of developing stiffness. Usual recovery time following surgery for ganglions ranges from two to three weeks for small ganglions of the finger, and six to eight weeks for ganglions involving the wrist.

For more information about ganglion cysts follow this link:

Ganglion cysts information >