Hand Microsurgery

Many sports such as badminton, squash, tennis, golf, martial arts, even swimming require a good, strong pair of upper limbs. Sports that uses the legs also needs the upper limb for balance and coordination. A fully functional hand can grip, the wrist can maneuver and shoulder swing at precise and optimal balance force, resulting in a better game.

With so much pressure placed on the hand and the upper limbs, it is little wonder that one of the most common injury in sports is at the hand or wrist. Wrist sprain (ligament injury, TFCC tear), tendinitis, tendon rupture (Mallet finger), Tennis elbow , Golfers elbow, fractures and some nerve compressions are the most common cases requiring hand microsurgery.

What exactly is hand microsurgery? Urban Health speaks to Dr Mohd Iskandar Mohd Amin, Consultant Orthopaedic, Hand and Microsurgeon at the Pantai Hospital Kuala Lumpur to know more about this lesser-known but increasingly popular sub-specialty in orthopaedic:

Dr Iskandar Amin

1)      How do sports affect the hand/s?

Dr Iskandar: Hand injuries, fractures and torn ligaments are common among people who play sports. Some of the reasons that lead to hand injures are poor preparation to play the game, lack of warming up, improper equipment, poor fitness levels or sometimes simply freak accidents. When one falls, the immediate reaction is to stretch the hand out to break the fall. With the full weight of the body being forced suddenly on one or both hands, the muscles, ligaments or bones at the wrist or fingers may get sprained, fractured or torn, more so if one falls in an awkward position. In competitive or contact sports, high velocity trauma can be expected if there is no proper protective gear.

2)      What is microsurgery?

Dr Iskandar: Microsurgery refers to surgeries that are done under magnification using surgical microscopes or loupes to pay more attention to details. Microsurgery to the hand became popular only after the World War Two, when war-stricken soldiers and commoners were subjected to varying degrees of injuries to the hand affecting the bones, joints, tendons, nerves, vessels and problem of skin cover in which structures are small and attention to detail is paramount important. Many medical sub-specialties also utilise microsurgery, such as in plastic and reconstructive surgery, general surgery, ophthalmology, orthopaedic surgery, gynecological surgery, neurosurgery and paediatric surgery.

3)      Why is hand microsurgery necessary for the hands?

Dr Iskandar: The hand is a unique and amazing organ. We use our hand to explore our world. Just think of the number of things that your hands do every day- you need it to hold, pick, touch, eat, type, text, work and everything in between. It’s so often taken for granted that not many people realise how important their hands are until it becomes injured. Beneath its surface is a maze of bones, ligaments, tendons, muscles, nerves and blood vessels. Every one of these elements must be in good order, coordinating your hand to function well. When any one of these element is damaged, reconstructive surgery needs to be very precise to avoid injuring the other connecting nerves and tissues. That is where hand microsurgery comes into the picture.

4)      What happens during surgery?

Dr Iskandar: Most of the surgery is usually done on a day care basis. The patient comes in the morning to be prepped for surgery.  Surgery is usually done under regional block or intravenous anesthesia and can take any time between 1-2 hours depending on the complexity of the injury. After surgery, the patient will be sent to the recovery room to rest for the next few hours. Transport arrangements need to be made to send the patient home after surgery to rest. More major cases where multiple structures are involved patient may be admitted for proper monitoring and pain relief.

5)      What is the after-care required following hand microsurgery?

Dr Iskandar: Surgery is only the beginning. For the next two weeks following the surgery, wound care is essential to keep the dressing clean and dry. Follow-up is usually after 1 week (for wound-cleaning) and 2 weeks (to remove the sutures). Physiotherapy is required almost all cases, from day one to the next few months following surgery to regain full function of the hand, fingers or arm. Our Hand Therapist work in tandem with the surgeon in controlling swelling and pain, designing splints and therapy regime to maximise outcome. They often present during the surgery to have better understanding of the follow up therapy treatment plan.

6)      Will I be able to play as well as before after surgery?

Dr Iskandar: Our aim of treatment is maximum restoration of function. In a straight forward case upon full recovery, most people can still get back to their game like before. The same applies for high performance sports people. Greater effort is required in order to get their hand back into shape for tournaments.

7)      What are the latest advancements in hand microsurgery?

Dr Iskandar: Hand surgeon does everything to the hand, skin cover, tendons nerves and vessels repair, fixing fractured bone, replacing joints, athroscopy of the wrist and elbow and even hand transplantation. We now use newer joint replacement materials such as SR™ PIP (Surface Replacement Proximal Inter Phalangeal), which makes it possible for small joints such as the fingers and wrist to stay supple and continue to have a wide range of movement after surgery. Keyhole surgeries also spell faster recovery times of 3-4 weeks, with the hands fully functional within a month or so. Since the surgery is now done as day procedures, hospital costs are reduced substantially.

Established in 1998, Pantai Hospital Kuala Lumpur’s Hand and Microsurgery Unit is a one-stop-centre for hand-related problems offering a full range of services including consultation, wound care,x-ray, reconstructive microsurgery, upper limb rehabilitation, occupational therapy, physiotherapy and custolmised splinting. The first private hospital in Malaysia to have a dedicated center for Hand & Microsurgery, PHKL houses 3 out of 12 of the country’s leading hand micro-surgeons.

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