Correction of hand function disorders using microsurgical techniques

What is hand microsurgery?

The hand is an anatomically complex and functionally diverse organ that plays a vital role in everyday human activities. Its unique structure determines its flexibility and ability to perform precise movements. The anatomical structure of the hand directly determines its functional capabilities, so any damage to the hand, even minor, can lead to potentially serious limitations. To minimize this risk, timely and accurate medical assessment of hand injuries is necessary.

The structural components of the hand include bones, tendons, nerves, blood vessels, and small joints, the coordinated work of which provides movement, sensitivity, the ability to touch, grasp, perform precise manipulations, and communicate. Nerve fibers transmit sensory information and provide innervation to muscles, which is necessary for both sensation and movement. Blood vessels supply oxygen and nutrients to tissues. Tendons, which connect muscles to bones, enable movement of the wrist and fingers. Small joints contribute to flexibility and a wide range of motion.

Any pathological condition that damages the structural elements of the hand leads to impaired function and a significant reduction in quality of life. In hand injuries, only the skin is sutured in the wound area, although both nerves and tendons may be damaged, resulting in numbness or impaired movement. At this time, it is necessary to consult a specialist and decide on a treatment plan, including surgery.

Hand microsurgery is a highly specialized field of surgery that enables precise surgical intervention on small structures (nerves, blood vessels, tendons) using surgical magnification optics, specialized microsurgical instruments, and atraumatic suture material. Microsurgical techniques play a decisive role in restoring hand function during the correction of traumatic injuries, congenital defects, and functional disorders that have developed as a result of various pathological conditions. Microsurgical restoration of nerves, blood vessels, and tendons, as well as reconstructive surgery, significantly improve functional outcomes and quality of life for patients.

The optimal time for surgical treatment of hand injuries is 3 weeks after the injury, although reconstruction is possible in later cases.

What types of microsurgical operations are performed at New Hospitals to correct hand function disorders?

To correct hand function disorders at New Hospitals, various types of microsurgical operations may be performed depending on the extent and location of the damage. The main areas are:

Microsurgical restoration  of nerves:

• Restoration of nerve integrity — used when nerve endings are close to each other and can be connected directly under a microscope using fine sutures.
• Peripheral nerve neurolysis — involves removing scar tissue around the nerve to restore its function. This procedure is effective in cases where the nerve is technically intact but its function is limited due to scarring.
• Endoneurolysis is a special form of neurolysis in which scar tissue is removed directly from the structures within the nerve. This procedure is used when the damaged nerve is preserved but scar tissue causes internal compression and prevents impulse transmission or regeneration.
• Nerve transposition — during surgery, the nerve is moved to a new anatomical position where it is no longer compressed or stretched. Transposition can be performed via submuscular, subcutaneous, or intramuscular access. Its purpose is to protect the nerve from secondary damage, improve function, and reduce pain.
• Peripheral nerve autografting — prescribed when direct repair of the damaged nerve is impossible or delayed.
• Nerve decompression — used for nerve compression syndromes such as carpal tunnel syndrome or cubital tunnel syndrome. The goal of the surgery is to remove the tissue causing the nerve compression and release the nerve.

Microsurgical restoration of tendons

• Restoration of tendon integrity  — used when the ends of the tendon can be joined directly. Sutures are applied using a special technique that ensures the tendon is strong and the surface is smooth to reduce the risk of adhesions forming.
• Tenolysis — involves freeing the tendon from scar tissue.
• Tendon transposition — if the damaged tendon cannot be repaired after the initial surgery, function can be restored by transferring another healthy tendon to the damaged area, which provides partial or complete restoration of lost function.
• Secondary tendon restoration, which is mainly prescribed for delayed treatment and involves removing scar tissue and reducing pain.

Reconstructive microsurgery:

• Finger replantation — a microsurgical operation to reattach an amputated finger or part of the hand, which involves fixing the bones and microscopically restoring the tendons, nerves, and blood vessels.
• Finger revascularization — restoration of blood flow to a finger or part of the hand when blood vessels are damaged, but without amputation.
• Correction of congenital defects — microsurgical techniques are used for the surgical correction of certain congenital defects, such as polydactyly (extra fingers) or syndactyly (webbing of the fingers).

What are the risks and complications of microsurgical hand surgery?

Hand microsurgery, like any surgical procedure, can be accompanied by certain complications. Although microsurgical techniques are designed to be precise and gentle on tissues, there is always a risk of complications. The following complications may develop after surgery:

• infection;
• bleeding;
• scar tissue formation;
• pain;
• nerve damage;
• limited mobility and incomplete restoration of function.