Urgent Care

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Treatment

Possible risks & problems

Surgical procedures represent a risk since the various tissues (nerves, arteries, tendons, etc.) lie close to each other in a confined space and anatomical variations of the hand, wrist and arm are common.

The surgeon operates with magnifying glasses on tissues drained of blood using a tourniquet to allow better recognition of the structures. Incisions are chosen according to the principles of plastic surgery, in such a way that formation of ugly scars is avoided. As far as possible, incision size is minimised and the least invasive methods are favoured.

Despite every precaution, problems may arise during or after an operation.

The following information relates to hand surgery in general and is not exhaustive; each specific case may require further explanation. Your surgeon is available to answer any questions which you may have, so please do not hesitate to put them to him or her.

Nerve damage
Sectioning by the scalpel of a few nerve fibres may lead to insensitivity in the corresponding innervation territory. Simple traction on a nerve may have a similar, transient effect lasting for a few days to a few weeks. The surgeon strives to avoid this type of injury. If he or she accidentally cuts a major nerve and realises it, he or she will repair it immediately, using a microsurgical technique; if such a lesion is secondary, it may require further intervention. These are risks inherent to hand surgery, the anatomy of which is complex and rich in nerves, some of which are very small.

Wound healing
The skin heals in 10-14 days, during which a dressing protects it. If it becomes wet, it must be removed, the wound must be disinfected and the dressing replaced. Healing then continues for several weeks or months. So-called red scars evade medical control. They are treated with creams, ultrasound, massage and sunblock. Scars then evolve, the collagen fibres comprising them are transformed and the scar becomes lighter and softens.

This evolution is highly variable from person to person and depends primarily on the genetic factors inherent to each person.

Complications, such as reopening of wounds, loosening of sutures and superficial infection can be controlled medically and rarely leave long-term sequelae. These complications are part of the risks inherent to any surgery.

Phlebitis on implantation of a catheter or after intravenous injections is rare and easily treated. These conditions may remain painful for several weeks.

Infections
While all precautions are taken, an infection is always possible (risk of 1 in 2,000 for so-called clean hand surgery, according to our own statistics). This is due to the penetration of a bacterial agent into the wound. These bacteria may derive from the host’s skin (deep pores, retreating of nails), be transported by the host’s blood from a remote site of infection (e.g. dental abscess, sinusitis, cystitis, etc.), or derive from ambient air, poorly sterilized instruments or a possible lack of aseptic conditions. Our professional teams are trained to prevent these before, during and after any operation.

Depending on the stage and extent of the infection, treatment consists of oral or intravenous antibiotics, immobilisation of the infected area (plaster or splint) and possibly surgery to clean the infection and drain it. Throbbing pain and fever are the first signs of this; it is always better to consult us if you have the least doubt, since infections which are recognised late are always more difficult to treat and may result in more severe sequelae.

Haematomas and bruising
This is due to local bleeding in the area of the operation, whether superficial (bruising) or deeper and concentrated (haematoma). Although bleeding is controlled during the operation by tourniquets or electrocoagulation, it may still arise as a secondary phenomenon during initial movements or when the tourniquet is loosened. Depending on the scale of surgery, one or more drains may be inserted at the end of the procedure and will be removed after a few hours and at most after 48 hours. Haematomas should be drained. Bruises are reabsorbed spontaneously within approximately 2-3 weeks.

Pain
Operations, particularly on joints and nerves, can lead to medium- to long-term pain and require specific rehabilitation treatment by our specialist occupational therapists, sometimes infiltration and in some cases, a new operation. We make every effort to keep pain following an operation to a minimum, treating tissues with care, reducing the duration of the operation and the tourniquet as much as possible and the risk of oedema, which are most frequently a source of pain.

The recommendations given to each patient before his or her return home play an important role in the prevention of pain and must be followed meticulously, as must the use of medications prescribed by the surgeon.

Algodystrophy (or complex regional pain syndrome or Sudeck’s atrophy)
This is a (largely unexplained) dysfunction of the regulation of the autonomous nervous system with an inflammatory reaction disproportionate to its primary cause; it can occur as a result of any trauma, such as a fracture and also after an operation.

It takes the form of severe swelling and stabbing pain usually involving the entire hand (even, for example, if the injury or surgery only initially involving a finger) and progressively by stiffness of the joints. The evolution is long, may last for one or two years and leave debilitating sequelae. It is therefore important to recognise the first symptoms and treat them early by administering appropriate medications and intensive occupational therapy to avoid stiffness.

The best thing to do is evidently to prevent this from arising. In order to prevent it, plasters and dressings should be comfortable and not too tight (do not hesitate to complain, if appropriate) and pain and oedema (tissue swelling) should be minimised. In this regard, the lifting and mobilisation recommendations given to you after each intervention play a certain preventive role and must be followed carefully.

Joint stiffness
Joint stiffness is also a complication which may arise after information, painful or prolonged immobilisation, hence the importance of following the recommendations made to you and, where appropriate, of well-managed rehabilitation under the direction of professionals. Our occupational therapists, who are all qualified and specialised, are here to take care of this, to support and facilitate your