This type of surgery requires a surgeon with extensive, specialized training in reconstruction, repair, or replacement of limbs, skin, joints and other affected tissue. Dr. Chariker was fellowship-trained in hand surgery at the renowned Kleinert Hand Institute, has extensive experience at the Navy's premier health care center in Virginia, and works with both adults and children on hand reconstruction. Medical advances have made it possible to perform surgeries that can restore full or partial functionality of the hand and greatly improve its appearance. Insurance often covers these procedures, which are often the result of accident or trauma.
- Carpal Tunnel
- Hand Injuries
Dr. Chariker performs reconstructive surgeries to correct deformities resulting from traumatic crush injuries, detachment of limbs or fingers, and burns that result in blood vessel or nerve damage. These procedures may include nerve and tendon repair, reattachment (microsurgical replantation) of detached limbs, and resetting of fractured bones. In many cases, Dr. Chariker is able to restore a significant degree of feeling and function to injured hands. However, recovery may take months. Additionally, a period of hand therapy will most often be needed.
Among the techniques Dr. Chariker uses:
- Grafting: the transfer of skin, bone, nerves, or other tissue from a healthy part of the body to repair the injured part.
- Flap surgery: moving the skin – along with its underlying fat, blood vessels and muscle – from a healthy part of the body to the injured site.
- Replantation or transplantation: restoring accidentally amputated fingers or hands using microsurgery, an extremely precise and delicate surgery performed under magnification. Some injuries may require several operations over an extended period of time.
Carpal Tunnel Syndrome
Carpal tunnel syndrome is a strain injury brought on by repetitive motion, overuse, or fluid retention. The carpal tunnel is the passageway through the wrist where tendons and major nerves reside. Pressure can build up and strain the nerves in this passageway causing uncomfortable tingling, aching, numbness, and impaired hand function. Although sometimes symptoms can be alleviated with splinting and anti-inflammatory medication, severe cases may require surgery. In this procedure, Dr. Chariker makes an incision from the middle of the palm to the wrist, then cuts the tissue that’s pressing on the nerve to release the pressure. He applies a dressing and splint after surgery to restrict motion and promote healing; the scar will gradually fade. The results of the surgery will depend in part on how long the condition has existed and how much damage has been done to the nerve.
Rheumatoid arthritis is an inflammation of the joints which restricts movement and disfigures the appearance of the hands and other parts of the body. Deformities can force joints and fingers into abnormally bent positions, restricting significant movement. In the severest cases of rheumatoid arthritis, hand surgery is necessary to restore the movement of joints. Dr. Chariker reconstructs areas of the hand or wrist by removing tissue from the inflamed joints, repositioning tendons, or implanting artificial joints. Although hand surgery can greatly improve the form and function of the affected joints, restoration may be an ongoing process involving several surgeries.
With Dupuytren's contracture, thick, scar-like tissue forms under the skin of the palm and may extend into the fingers, pulling them toward the palm and restricting motion. The condition usually develops in mid-life and has no known cause, though it has a tendency to run in families. Surgery is the only treatment. In this procedure, Dr. Chariker cuts and separates the bands of thickened tissue, freeing the tendons and allowing better finger movement. The operation must be done very precisely since the nerves that supply the hand and fingers are often tightly bound up in the abnormal tissue. In some cases, skin grafts are also needed to replace tightened and puckered skin. The results of the surgery will depend on the severity of the condition. You can usually expect significant improvement in function, particularly after physical therapy and a fairly inconspicuous scar.
Recovery, Rehabilitation and Risks
Since the hand is a very sensitive part of the body, you may have mild to severe pain following surgery along with swelling. Dr. Chariker will prescribe pain medication to manage your discomfort. The type and extent of surgery will dictate how long your hand must remain immobilized. Furthermore, your individual healing progress will determine how quickly you resume your normal activities. Dr. Chariker will likely recommend a course of physical therapy to speed your recovery and give you the fullest possible use of your hand. In all types of hand surgery, the possible complications include infection, poor healing, loss of feeling or motion, blood clots, and adverse reactions to the anesthesia. These complications are infrequent, however, and can generally be treated.