Reconstructive Hand & Wrist Surgery

🛠️ Reconstructive Hand & Wrist Surgery

Reconstructive hand and wrist surgery is a specialized area of orthopedic and plastic surgery focused on restoring function, appearance, and strength to the hand, fingers, and wrist after injury, disease, deformity, or congenital abnormalities. The complexity of the hand—with its bones, tendons, ligaments, nerves, and blood vessels—requires precise, often microsurgical techniques.

✅ Indications for Reconstructive Surgery

1. Trauma

Fractures, dislocations

Tendon or nerve lacerations

Crush or avulsion injuries

Amputations and replantations

2. Degenerative Diseases

Osteoarthritis (OA)

Rheumatoid arthritis (RA)

Ligament instability (e.g., scapholunate)

Collapsing wrist (e.g., SLAC/SNAC wrist)

3. Congenital Deformities

Syndactyly, polydactyly, thumb hypoplasia

Radial club hand

4. Tumors or Masses

Ganglion cysts

Bone or soft tissue tumors

5. Nerve Compression

Carpal tunnel syndrome

Cubital tunnel syndrome

6. Functional Loss

Brachial plexus injury

Stroke or cerebral palsy-related deformities

Dupuytren’s contracture

🧰 Common Surgical Procedures

🔹 Fracture Fixation

Plates, screws, or pins for metacarpal, phalangeal, or distal radius fractures

Realignment to restore motion and grip strength

🔹 Tendon Repair or Transfer

Flexor/extensor tendon repairs

Tendon transfers for nerve palsies (e.g., radial nerve palsy → wrist drop correction)

🔹 Nerve Surgery

Nerve grafts or conduits for traumatic injuries

Microsurgical repair for sharp lacerations

Nerve decompression (e.g., carpal tunnel release)

🔹 Joint Reconstruction or Fusion

Arthroplasty (joint replacement) for small joints (e.g., MCP, PIP)

Arthrodesis (fusion) for pain relief and stability

Used in advanced arthritis or instability

🔹 Ligament and Soft Tissue Repair

TFCC repair (Triangular Fibrocartilage Complex)

Scapholunate ligament reconstruction

Wrist stabilization for chronic instability

🔹 Flap Surgery / Free Tissue Transfer

Soft tissue reconstruction using local or free flaps

Microsurgical techniques for complex wounds

🔹 Amputation & Prosthetic Integration

Revision of traumatic amputations

Preparing the limb for functional prosthetics (e.g., myoelectric)

🧪 Advanced & Emerging Techniques

3D-printed bone and joint implants

Arthroscopic wrist surgery (minimally invasive)

Biologic injections (e.g., PRP, stem cells)

Robotic-assisted microsurgery (experimental)

🧑‍⚕️ Multidisciplinary Approach

Hand surgeons (plastic or orthopedic)

Therapists for post-op rehabilitation

Pain management specialists

Rheumatologists or neurologists if underlying systemic disease

🎯 Goals of Reconstructive Surgery

Restore mobility, strength, and coordination

Minimize pain, stiffness, and deformity

Improve independence and quality of life

Optimize cosmetic appearance when possible