In this section
Our team of experienced hand surgeons see and treat a range of hand and wrist problems, from the common to the complex.
Many of our hand surgeons hold the Diploma in Hand Surgery and are members of the British Society for Surgery of the Hand, and in addition to training in plastic surgery have undertaken additional fellowships in hand and upper limb surgery.
Treatment for painful or functionally limiting problems of the hand and wrist
We understand how debilitating problems with the hand and wrist can be, and we can provide assessment, diagnosis and management for patients with painful, deforming or otherwise functionally limiting problems of the hand and wrist. Common complaints we see include Dupuytren’s contracture, carpal tunnel syndrome, rheumatoid and osteoarthritis, trigger fingers, De Quervain’s disease, cubital tunnel syndrome, and instability of the ligaments of the wrist.
Children’s hand surgery
We receive many referrals from neonatologists, paediatricians, GPs and midwives to see babies and children born with differences to their hands. Please see the section on paediatric plastic surgery for more information.
Emergency surgery for hand injuries and infections
MFT offers a full microsurgical reconstructive service for adults and children with hand injuries ranging from the most minor to the most complex, including reimplantation (reattaching severed digits, hands or limbs), revascularisation (restoring blood flow when there is an injury to the arteries), fixation of fractures, and repair of nerves, tendons, blood vessels and skin.
At RMCH we offer emergency surgery to children with hand injuries, and we see and treat over 500 children per year. However, for the most complex cases, children may be directed to MFT where we have the facilities for microsurgery and complex reconstruction.
Access to the emergency service is directly via MFT A&E, or by referral from another A&E department, GP, walk-in centre or urgent care facility.
When you are seen by our team your injured hand will be examined and a detailed account of the injury and your medical history will be taken. The trauma team will prioritise you according to the severity of your injury, and will list you for surgery.
We divide injuries into the following categories, which we list here for your information, to help you understand the length of time you may need to wait for surgery:
Immediate: injuries such as amputations, severed arteries or severe infections that need an operation within six hours to save life or limb.
Urgent: injuries such as open fractures, damage to flexor tendons or major nerves, or injuries from dogbites, fenceposts, glass etc, that need an operation ideally within 48 hours, although slightly longer may be acceptable following review by the surgical team.
Scheduled: injuries such as damage to extensor tendons, minor nerves, the skin of the hand, or other injuries such as closed fractures, where the risk of infection is low, and an operation within 5-10 days at a convenient time for the patient is appropriate.
Please note that these timescales are indicative,and our service must remain flexible to cope with changes in workload. Our general aim is to operate on all urgent cases within 24 hours and all scheduled cases within three days.
Hand therapy
At MFT we have an experienced and nationally-renowned team of hand physiotherapists and occupational therapists who share care of our patients with the surgeons. They are responsible for fitting and adjusting splints, advising on appropriate exercises, monitoring healing, and working with our surgeons to monitor progress of our patients.
Much of your follow-up will be with our trusted team of therapists, rather than the surgeons, as access to and time in the therapy clinics is much more flexible than appointments with the surgeons. If your therapist feels that you need review by a hand surgeon, this will be organised promptly.
Referrals
Patients with long term conditions are referred into the service by GPs, other specialists, and sometimes “Tier 2” services such as community musculoskeletal practitioners. Your GP should be able to choose the plastic surgery hand service when she or he completes a Choose and Book referral for you.