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What is Hand Surgery and Microsurgery?
Hand surgery and microsurgery are two crucial treatment approaches that focus on the health of your hands and wrists, yet operate at different levels of depth.
Hand surgery is a specialized surgical field that encompasses all tissues in the hand and wrist region, including bones, joints, muscles, tendons, nerves, and skin. This specialty deals not only with the treatment of acute injuries (fractures, lacerations, crush injuries) but also meticulously addresses long-standing conditions and congenital deformities or birth defects.
Microsurgery, on the other hand, is a more advanced technique that aims to repair delicate structures such as blood vessels (especially those less than 1 mm in diameter), nerves, and very small tissue parts that are not visible or are very difficult to see with the naked eye. Thanks to this unique treatment method, complex injuries and conditions that were once untreatable or would have resulted in limb loss can now be successfully treated.
At MSM Klinik, we offer our patients a combination of hand surgical and microsurgical approaches. The combined application of these two specialties often enables the optimal restoration of your hand’s function. Through this integrated approach, conditions that previously would have led to limb or functional loss can now result in successful outcomes where the hand regains its full functionality. Our goal is to prioritize each patient’s comfort and ensure their hands achieve their former health and best possible function.
Main Applications of Hand Surgery and Microsurgery
Hand surgery and microsurgery cover a broad spectrum of treatments focused on restoring the function and aesthetics of your hands:
- Replantation of Severed Limbs: This is one of the most life-saving applications of microsurgery. Completely or partially severed fingers, hands, or other limbs, detached due to traumatic accidents, are reattached. Under a microscope, the finest arteries, veins, nerves, and tendons are meticulously repaired.
- Nerve Injuries and Compressions:
- Nerve Lacerations: For injuries caused by sharp objects, damaged nerve ends are precisely connected using microsurgical techniques. The goal is to restore the functions of sensation and movement.
- Nerve Compressions: In conditions like carpal tunnel syndrome in the wrist or cubital tunnel syndrome at the elbow, pressure on the nerve is precisely relieved using microsurgical techniques. These conditions often lead to pain, numbness, and loss of strength.
- Vascular Injuries and Repairs: In cases of injuries or blockages of the very small blood vessels that supply blood to the hand, these vessels are connected using microsurgery. This is vitally important for tissue survival.
- Tissue Transfers (Free Flap Surgery): In cases of significant tissue loss (e.g., after deep burns or tumor removal), a piece of tissue from another part of the body – along with its own blood vessels and nerves – is transferred to the damaged area using microsurgical methods. This enables both aesthetic and functional improvement.
- Tendon Injuries and Problems:
- Tendon Ruptures: When tendons, which connect muscles to bones, tear or rupture, the tendon ends are reconnected using microsurgical principles.
- Tendon Impingement: Movement restrictions caused by inflammation or narrowing of tendon sheaths, such as in “trigger finger” (Digitus saltans), are treated.
- Hand and Wrist Fractures: The repair of bone fractures in the hand and wrist area may require surgical intervention, especially for fractures affecting joint surfaces or complex fractures.
- Congenital Hand Anomalies: The correction of hand and finger deformities like fused fingers (syndactyly) or extra fingers (polydactyly) aims for functional and aesthetic improvement.
- Hand Tumors and Cysts: This involves the correct diagnosis and surgical removal of benign or, rarely, malignant growths that develop in the hand.
What's the Difference Between Classic (Open) Surgery and Microsurgery?
The fundamental distinction in surgical procedures lies in the level of precision and the techniques used:
- Classic (Open) Surgery: This method involves the surgeon directly accessing the surgical area through a large incision. While it offers a broad field of view, it has disadvantages such as greater tissue trauma, a longer healing period, and more noticeable scars.
- Microsurgery: This technique is performed using the “keyhole principle,” entering through the smallest possible incision. This minimally invasive approach is carried out with the aid of operating microscopes or special loupes (magnifying glasses) and extremely precise, fine instruments. While open surgery provides direct access and versatility, microsurgery minimizes trauma, leading to faster healing and less scarring. It offers significant advantages, especially for delicate procedures like tendon lacerations and microsurgical tendon repair.
The Importance of Microsurgery in Hand Surgery
Bones, muscles, tendons, blood vessels, and nerves form a dense and complex structure within a small area like the hand. Therefore, it’s crucial to seek the opinion of microsurgery specialists, such as those at MSM Klinik, especially for specific conditions like nerve injury treatment, to achieve the maximum restoration of your hand’s function.
Here’s why microsurgery is so superior in hand surgery:
- Preservation and Restoration of Function: Our goal with hand injuries isn’t just to close the wound, but to fully restore complex hand functions like grasping, holding, and feeling. In microsurgical nerve repairs, nerve endings are precisely connected at a millimetric level to regain sensation and mobility. Techniques like microsurgical nerve regeneration, microsurgical nerve transfer, and microsurgical end-to-end nerve repair significantly aid in restoring lost functions. Achieving this level of functional recovery is nearly impossible with classic methods.
- Saving Severed Limbs (Replantation): In emergencies, such as a finger amputation or more extensive limb loss, restoring blood circulation to the severed part is critically important. Microsurgery enables the successful connection of these delicate arteries and veins to preserve the limb’s viability and allow for its reattachment.
- Effective Treatment of Nerve Compressions: For conditions like carpal tunnel syndrome, ulnar nerve compression, or other nerve compressions in the elbow, microsurgical techniques precisely remove pressure on the nerve without damaging surrounding tissue. This approach accelerates healing and increases the treatment’s success rate.
- Excellent Results in Tendon and Muscle Repairs: During muscle tear treatment or tendon tear treatment, the precise and tension-free repair of torn structures is vital for the complete restoration of mobility. Microsurgery allows for the most precise execution of these repairs. Significant benefits from microsurgery are also seen in the treatment of finger tendon tears and ligament tear treatment.
Frequently Asked Questions
- What is Hand Surgery?
Hand surgery is a specialized medical field that encompasses the surgical treatment of all tissues in the hand and wrist area, including bones, joints, muscles, tendons, nerves, and skin. Injuries, chronic conditions, and congenital deformities are the areas of expertise within this field. Its goal is to preserve and restore the function and aesthetics of the hand to the highest possible level.
- What is Microsurgery and Why is it So Important in Hand Surgery?
Microsurgery refers to advanced and precise surgical techniques performed at a “micro” scale, meaning very small. In this method, surgeons use special microscopes that can magnify the surgical field tenfold, along with sutures thinner than a strand of hair, and instruments with millimetric precision. Microsurgery is crucial for repairing structures that are invisible to the naked eye, such as very small blood vessels, nerves, and tendons within the complex structure of the hand. At our clinic, we combine hand surgical and microsurgical approaches to optimally restore the function of your hand.
- What is the Main Difference Between Classic Surgery and Microsurgery?
Classic (open) surgery is typically performed with larger incisions, whereas microsurgery follows the “keyhole principle,” entering through the smallest possible incision. Because microsurgery operates under very high magnification, damage to surrounding tissues is minimized, offering advantages such as less bleeding, faster healing, and smaller scars.
- What are the Main Advantages of Microsurgery?
Microsurgery offers minimal tissue damage, less bleeding, a rapid healing process, excellent cosmetic results, and a high success rate for precise procedures like microsurgical nerve repair or microsurgical vascular repair.
- Can a Severed Limb (Finger/Hand) Be Reattached Microsurgically?
Yes, the replantation of severed limbs is one of the most well-known and life-saving applications of microsurgery. With microsurgery, the arteries, veins, nerves, and tendons of the severed limb are precisely repaired to restore its viability and function.
- How Are Nerve Injuries Treated and How Long Does the Healing Process Take?
In injuries like nerve lacerations, the nerve ends are joined with millimetric precision using microsurgery. For larger nerve gaps, nerve grafts can also be used. Nerve healing (regeneration) is a slow process, progressing at approximately 1 mm per day. Full recovery can take months, or even years, depending on the location and severity of the injury. Physical therapy is a very important part of this process.
- Can Nerve Compressions Like Carpal Tunnel Syndrome Be Treated Microsurgically?
Yes, carpal tunnel syndrome, cubital tunnel syndrome, and other nerve compression syndromes can be successfully treated with microsurgical techniques. Thanks to microsurgery, pressure on the nerve is precisely relieved without damaging surrounding tissues. This approach accelerates healing and increases the treatment’s success rate.
- When Is Hand Surgery Necessary?
Hand surgery may be necessary in many situations, such as hand and wrist fractures, tendon ruptures, nerve lacerations, burns, nerve compressions, osteoarthritis in the hand, deformities due to rheumatic diseases, congenital hand anomalies, and tumors or cysts in the hand.
- Are Microsurgical Operations Painful?
Since the operation is performed under anesthesia, you won’t feel any pain. Postoperative pain is typically much less than with classic surgery due to minimal tissue damage and can be managed with simple painkillers.
- How Is a Tendon Rupture Treated?
Tendon rupture treatment usually involves surgical intervention. The torn tendon ends are precisely reconnected following microsurgical principles. Postoperative physical therapy is critical for strengthening the tendon and regaining range of motion.
- Why Is Physical Therapy Important After Hand Surgery?
Physical therapy after hand surgery is vitally important for restoring the function of the operated area, increasing range of motion, restoring muscle strength, and reducing swelling. Physical therapy also plays a supportive role in processes like nerve healing.
- Is Microsurgery Used in the Treatment of Wrist Fractures?
Not every wrist fracture treatment requires microsurgery. However, if vascular or nerve injuries accompany the fracture, or if complex reconstructions are necessary, microsurgical techniques may be employed.
- Why Do Fingers Tingle and How Is It Treated?
Finger tingling is typically a symptom of nerve compression (most commonly carpal tunnel syndrome or cubital tunnel syndrome). After diagnosis, pressure on the nerve is relieved through conservative treatment (splint, medication) or surgical intervention.
- What Types of Microsurgical Operations Is MSM Klinik Specialized In?
At our clinic, we have extensive expertise in microsurgical applications, particularly in the field of hand surgery (nerve repair, vascular repair, tendon repair, replantation, free tissue transfers), and in the treatment of nerve compressions (e.g., carpal tunnel syndrome).
- What Are the Main Risks of Microsurgery?
As with any surgical procedure, microsurgery carries potential risks such as infection, bleeding, wound healing problems, the (very low) risk of nerve damage, and anesthesia-related complications. However, due to its minimally invasive nature, these risks are generally lower than with classic surgery.
- What Do “Tissue Transfer” or “Flap Surgery” Mean in Hand Surgery?
Tissue transfer (flap surgery) means the transplantation of a piece of tissue (along with its own blood vessels and nerves) from another part of the body to the damaged area. This procedure is frequently used for large tissue losses (after burns, tumor removal) for both aesthetic and functional restoration.
- How Fine Are the Instruments and Sutures Used in Microsurgery?
In microsurgery, surgeons use operating microscopes that can magnify the surgical field tenfold. The surgical instruments used are extremely precise and millimetric in size. The sutures are even finer than a human hair (they are numbered as 8-0, 9-0, 10-0, etc.).
