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U.S. Department of Health and Human Services
Health Resources and Services Administration
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Reconstructive Surgery on the Hand

Reconstructive surgery is primarily performed to rebalance the hand for useful function. It can also often improve the appearance of the hand cosmetically, and in doing so, improve the patient's self-image.

Hand therapy image.

The real reason for reconstructive surgery is to rebalance the hand and fingers in order that they work in normal positions that allow the hand to be used satisfactorily.   Post-operative rehabilitation is needed in order to make the surgery successful and maximize the result.  Hand therapists have developed specialized techniques for the restoration of hand function that maximize the effectiveness of reconstructive surgery.

Hand therapy finger exercises image.Hand therapy palm exercises image.

Reconstructive surgery should be performed while the fingers are still supple as later when contractures have become fixed, optimum surgical results are harder to achieve.  Many surgical procedures have been developed by Brand and other plastic and orthopedic hand surgeons that can restore normal balance to the fingers.  Brand's "Index of Muscles" is an excellent reference for understanding the relative potential strength and excursion of the muscles of the forearm and hand.

Hands that have developed contractures image.

Hands that have already developed contractures can often be improved by reconstructive surgery, but a period of treatment to reduce the contracted joints and remobilize fingers and thumbs is often required before surgery can be effective.  This is because a joint that is stiff before surgery will also be stiff after surgery, unless mobilization of the skin tissue and bony joints has been achieved.

Reconstructive surgery in hands that have developed fixed contractures and finger absorption image.

Reconstructive surgery in hands that have developed fixed contractures and finger absorption should be approached carefully, as it is not always possible to restore normal use.  Surgical improvement is not always warranted as the patient has functioned for a long period with his hands in learned patterns.  Surgery is most helpful to restore a particularly desired function, such as pinch, or a movement that a patient desires for work or recreation - such as playing a musical instrument or golf - that give quality of life.