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In the upper extremities, surgery is used to treat entrapment neuropathies related to Hansen's disease.
Carpal tunnel release is performed for the median nerve at the wrist and anterior transposition of the ulnar nerve at the elbow.
Tendon transfers are performed to rebalance the paralytic hand in order to distribute the forces equally.
An intrinsic minus hand with clawing is corrected by tendon transfers. Tendon transfers are performed on the thumb to improve the power of key pinch and to provide opposition to the fingers.
Surgical arthrodesis is used to stabilize unstable or destroyed joints.
Surgical debridement and limited amputations may be required for infections related to wounds on the insensate hand.
Skin grafts can surgically release contractures, if needed.
Cosmetic procedures are available to improve the overall appearance of the hand thus reducing some of the stigma of Hansen's disease.
More about Surgical Reconstruction of the Hand
In the lower extremities, surgical procedures are available to assist wounds to heal or as reconstructive procedures to prevent ulceration.
Surgical debridement, including debridement of infected bone in osteomyelitis, is often required for open wounds with non-viable tissue.
Skin grafts or flaps may aid in wound healing once a wound is devoid of all non-viable tissue,
Either arthrodesis or osteotomy may be used to correct rigid bony deformities in high-pressure areas. Correction of toe deformities, such as claw-toe, may prevent ulceration in high-pressure areas.
Tendon transfers are available to rebalance a paralytic foot, such as posterior tibialis transfer for foot drop.
Tendon release procedures, such as a tendo Achilles lengthening, will help reduce high-pressure areas.
Amputation may be required for uncontrollable sepsis, an avascular extremity or when function will be increased by prosthetic usage.
Surgical Rehabilitation of the Hand
Careful coordination of surgery with pre- and post-operative therapy maximizes surgical results and often is the difference between a successful and an unsuccessful surgical result. The therapist has the best advantage in making a difference to the results of surgery if the patient can been seen ahead of time for pre-operative evaluation that can be compared to post-operative measurements.
Following surgery and a period of immobilization, there is a "golden" period of approximately three weeks when therapy can enhance or insure reconstructive procedures. Because there are many small bones and joints in the hand with tendons which have to glide in order to produce movement, the period a hand must be immobilized for healing can be detrimental. Tissues glue together in one wound when healing, and scar begins to form. It is important that gliding surfaces be moved and that movement be made to the full extent of allowable limits as soon as possible. There is always scar that forms on healing, but careful and specific movement allows scar to form and support where desired, but not to inhibit function where not desired.
Generally, best results are achieved when a patient can be weaned away from an immobilizing bandage or cast - not just released and allowed to use the hand. They must learn and accept new ways of using the hand to maximize the results of surgery, and avoid old habit patterns they developed in order to use the hand when it was impaired. A return to old patterns of hand use can in some cases undo the surgery, or recreate the same contractures of imbalance of the fingers. Often additional splinting is needed to optimize positioning or support new tendon transfers until they become strong enough to perform intended functions.