Hand Surgery is surgery of the hand, wrist and all the nerves running along the arm and hand. It includes all reconstructive surgery that restores and form and function of the hand and fingers. Hand problems can occur spontaneously, over time (chronic), are traumatic, or congenital.
As part of his extensive surgical training, Dr Stasch has worked in a Plasti Surgery unit which also specialized in Hand Surgery – allowing him to learn from the best (Luisenhospital Aachen, Germany) and treating thousands of hand surgical conditions, including highly complex microsurgical reconstructions, wrist arthroscopy for ligamental and meniscus damage, joint replacements and joint fusion, distal radius fractures and peripheral nerve surgery. His practical qualifications and successfully completed exams earned him the additional academic title “Facharzt für Hand Chirurgie” (Specialist in Handsurgery) from the Federal Medical Board in Duesseldorf, North-Rhine Westphalia.
In Nairobi, the most common conditions in handsurgery that we perform involve the following:
At the Vitality Fountain Clinic, we use clinically proven techniques for carpal tunnel release surgery. Aim of the surgery is to ease pain and numbness in your hand and wrist that’s caused by carpal tunnel syndrome.
Carpal tunnel syndrome is caused by swelling in your wrist which puts pressure on your median nerve – supplying mainly your three radial fingers from thumb, index and middle finger.
If your CTS is mild, non-surgical treatments such as a splint or steroid injection may relieve your symptoms. If these aren’t successful or if permanent nerve damage is possible, surgery will be advised.
During surgery, Dr Stasch will release the ligament that runs across the front of your wrist bones to relieve the pressure.
The procedure is also called Carpal tunnel decompression or Carpal tunnel release.
At a glance
• Typical Clinic stay: Same day discharge
• Procedure duration: 20 minutes
• Type of anaesthetic: Local
• Available to self-pay? Yes
• Covered by health insurance? Yes
Thumb arthritis occurs due to the trapezium bone in your wrist at the base of your thumb being affected by osteoarthritis (wear and tear).
If you suffer from thumb arthritis, you’ll feel pain where your thumb joins your wrist. The pain is usually noticed when you use your thumb or wrist, pinching or twisting. Thumb arthritis is more common in women aged 50 years and above, but many men suffer from it too.
At the Vitality Fountain Clinic we will diagnose thumb arthritis based on our expertise and an x-ray.
Although steroid injections can be attempted to treat thumb arthritis, more revolutionary therapies like fatgrafting is our first choice in mild and moderate thumb arthritis conditions: Several studies have shown that this simple prodedure relieves pain and symptoms in 80% of patients long-term. Th mchanism is thought to be effective due to the stem cells in your fat and additional lubricating layer between the arthritic bones.
For severe forms of arthritis, or when previous therapies did not resolve the pain completely, thumb arthritis surgery such as the day case procedure called trapeziectomy will be performed under general anaesthetic. It takes approximately one hour and involves removing the trapezium bone.
At a glance (Fatgrafting for thumb arthritis)
• Typical Clinic stay: Same day discharge
• Procedure duration: 45 minutes
• Type of anaesthetic: Local
• Available to self-pay? Yes
• Covered by health insurance? Yes
Trigger finger (or “Snapping finger”) occurs when your finger becomes temporarily or permanently locked in position in the palm of your hand making it difficult to straighten. This happens when the tendon in the palm of your hand thickens and gets stuck in the fibrous bands that hold your tendons in place.
Dr Stasch may recommend surgery to correct your trigger finger, usually if other treatments such as steroid injections, anti-inflammatories and a splint have proven unsuccessful.
Trigger finger can happen spontaneously. It is a condition that is more likely to affect women than men and is more common in people in their 40s and 50s. Inuries to your hand, medical conditions including diabetes, rheumatoid arthritis, gout, carpal tunnel syndrome, Dupuytren’s contracture and some other hand conditions can precipitate the appearance of trigger fingers.
At a glance
• Typical Clinic stay: Same day discharge
• Procedure duration: 15 - 20 minutes
• Type of anaesthetic: Local
• Available to self-pay? Yes
• Covered by health insurance? Yes
Dupuytren’s contracture occurs when the fascia and skin in your palm and fingers becomes thickened, tight and occasionally painful. It can progress and cause your fingers to become bent and unable to fully straighten.
Dr Stasch will be able to diagnose this disorder without any special tests.
The best type of surgery to treat this condition is called partial fasciotomy and involves dividing the diseased fibrous bands in the palm of your hand and fingers and removing all of the affected tissue. In severe cases this might involve using small skin grafts.
We will recommend the most appropriate treatment based on the severity of your contracture.
At a glance
• Typical hospital stay: Same day discharge or 1 night
• Procedure duration: 45 - 180 minutes depending on severity
• Type of anaesthetic: regional arm block or GA
• Available to self-pay? Yes
• Covered by health insurance? Yes
Ganglions are fluid filled cysts or lumps which are typically found on your wrist or hand - in particular on the back of your wrist (ganglion) or on your fingertips (then its called a mucous cyst). Ganglions can occur spontaneously or after injuring your hand. While ganglions are usually not painful, larger ganglions can be unsightly and are sometimes painful.
Dr Stasch will be able to diagnose a ganglion or mucous cyst by examination alone.
Commonly, you can leave your ganglion untreated if it is not causing you pain or distress. Most people however opt to have them removed by minor surgery called an excision. It’s performed as an outpatient procedure under local anaesthetic and simply involves removing the ganglion. In some circumstances, ganglions can return to the same site in the future. We will aim to avoid this with meticulous surgery.
At a glance
• Typical Clinic stay: Same day discharge
• Procedure duration: 30 -45 minutes
• Type of anaesthetic: Local
• Available to self-pay? Yes
• Covered by health insurance? Yes
What is syndactyly?
If your child has syndactyly, it means that the fingers or toes are webbed or joined. This condition would have been present at birth. Syndactyly is a fairly common congenital defect that often runs in families, affecting about 1 out of every 2,500 babies. Boys are more likely to have it than girls.
Syndactyly affects both hands (bilateral) about half of the time and most often occurs between the middle and ring fingers. It also can affect a child’s toes as well as fingers.
In most cases, surgery can restore the appearance of the fingers and thereby allow the child to undergo normal development and have a normal function of the hand.
Treatment of syndactyly?
Dr Stasch will examine the hands and toes, and in most cases an X-Ray picture will be needed. Surgery involves cutting through the skin that covers the affected fingers in a zig-zag fashion, and use the same skin to cover the now separated fingers. Sometimes, small skin grafts are necessary to close all defects.
At a glance
• Typical hospital stay: Same day discharge or 1 night
• Procedure duration: 45 - 120 minutes depending on severity and fingers involved
• Type of anaesthetic: regional or GA
• Available to self-pay? Yes
• Covered by health insurance? Yes
Fingertip injuries
Fingertip injuries can occur in accidents at home, work, or when in nature riding a horse, climbing a fence or fighting off wild animals. An injury can involve a sharp cut, a crushing injury, a tearing injury, or a combination of these injury types. An amputation can result from slamming your finger in a car door or catching your ring on a hook or nail.
An injury or amputation can damage any part of the fingertip, including the:
· Skin and soft tissue
· Fingertip bone (distal phalanx)
· Nail and underlying nailbed
Your fingertips are rich with nerves and are extremely sensitive. Without prompt and proper treatment, a fingertip injury can cause problems with hand function, and may even result in permanent deformity or disability. To ensure the best outcome, it is important to have Dr Stasch examine your finger or thumb after an injury.
First Aid for fingertip injuries
Following an injury or even amputation of your finger, do the following as you are preparing to see your doctor:
· Clean the injury with sterile Saline or clean water and cover it with a lightly compressive sterile dressing to minimize bleeding and protect the injured finger.
· Elevate the injured hand to minimize swelling.
· Immobilize the affected hand with a short splint.
Finger amputation:
If your fingertip is completely cut off, do the following:
· Gently clean the amputated part with water or, if possible, with sterile saline solution.
· Cover it in a moistened gauze.
· Place it in a watertight bag.
· Place the bag in a sealed container filled with a mixtre of water and ice.
· Do not allow the amputated part to be in direct contact with ice. You could damage it further.
· Bring the amputated part with you to the emergency room and maintain control over it until the doctor is able to evaluate you.
Treatment of fingertip injuries
The aim of treating the fingertip injury is to have a pain-free finger that is covered by healthy skin and functions normally. We will always try to preserve the length and appearance of your finger.
Treatment for a fingertip injury or amputation depends on the angle of the cut and the extent of the injury. In Dr Staschs long handsurgical experience, it has shown that less is often more in order to allow the finger to heal perfectly.
We will assess your injury and advise on the way forward – wether it will involve surgical reconstruction or conservative occlusive dressing therapy.
Surgical drainage or debridement hand infections
Hand infections are very common. Treatment for hand infections may include rest, using cold or heat, elevation, antibiotics, and surgery. If there is a sore or abscess in the hand, surgical drainage may help remove any pus which immediately relieves any pain. If the infection or wound is severe, debridement may be used to clean dead and contaminated tissue from the wound. This prevents further infection and helps promote healing.
Replantation of fingers and limbs
This type of surgery reattaches a body part, such as a finger, hand, or toe, which has been completely cut or severed from the body. The goal is to restore as much function as possible. Replantation uses microsurgery which Dr Stasch performs at the Aga Khan University Hospital. This is a complex type of surgery that uses tiny tools and is done under magnification using a microscope. In most cases, more than one surgery may be needed.
Tendon Repairs
Tendons are the structures that join muscle to bone. Hand and finger tendon repair in the hand is a challenging surgery because of the structure of the tendon – and needs to have meticulous technique to allow return to normal function.
Tendon injuries can occur due to infection, trauma, or sudden rupture.
The 3 types of tendon repair involve: primary, delayed primary, or secondary tendon repair.
Primary repair of a sudden injury is often done within 24 hours of the injury. The aim is to repair the tendon to allow gliding and movement of the finger.
Delayed primary repair is usually done a few days after the injury, usually when there are other injuries which have to be attended to first.
Secondary repairs may occur a few weeks after the injury. This may include tendon grafts: we harvest other tendons from other areas of the body which are then inserted in place of the damaged tendon. Other more complex procedures may involve using functioning tendons and redirecting them so their function replaces the more important functions of the damaged tendon.
Nerve repairs
Trauma or injury to your hand can damage the nerves found in the hand. This can cause a loss of hand function and a loss of feeling in the hand. While some nerve injuries heal on their own, others may require surgery.
The best time for nerve repairs on the hand is usually primarily (immediate) or delayed (3-6 weeks after the injury) depending on the cirumstances.
The earlier and more accurate the repair, the higher the chance of a full recovery. If the nerve is cut or severed, it may be fixed by reattaching it to the other end of the nerve, or by performing a graft where another nerve is talen from another part of the body, replacing the more important but injured nerve.
Once surgery is done, the nerve will recover at a rate of about 1mm per day. Recovery will involve wound care, physiotherapy and nerve stimualtion.
Following an injury or even amputation of your finger, do the following as you are preparing to see your doctor:
Clean the injury with sterile Saline or clean water and cover it with a lightly compressive sterile dressing to minimize bleeding and protect the injured finger.
Elevate the injured hand to minimize swelling.
Immobilize the affected hand with a short splint.
Finger amputation:
If your fingertip is completely cut off, do the following:
• Gently clean the amputated part with water or, if possible, with sterile saline solution.
• Cover it in a moistened gauze.
• Place it in a watertight bag.
• Place the bag in a sealed container filled with a mixtre of water and ice.
Do not allow the amputated part to be in direct contact with ice. You could damage it further.
Bring the amputated part with you to the emergency room and maintain control over it until the doctor is able to evaluate you.
Hand infections are very common. Treatment for hand infections may include rest, using cold or heat, elevation, antibiotics, and surgery. If there is a sore or abscess in the hand, surgical drainage may help remove any pus which immediately relieves any pain. If the infection or wound is severe, debridement may be used to clean dead and contaminated tissue from the wound. This prevents further infection and helps promote healing.
Replantation of fingers and limbs
This type of surgery reattaches a body part, such as a finger, hand, or toe, which has been completely cut or severed from the body. The goal is to restore as much function as possible. Replantation uses microsurgery which Dr Stasch performs at the Aga Khan University Hospital. This is a complex type of surgery that uses tiny tools and is done under magnification using a microscope. In most cases, more than one surgery may be needed.
