Risks and potential problems

Any surgical procedure carries a risk, as the various tissues (nerves, arteries, tendons, etc.) are located close together in a small space, and anatomical variations in the hand, wrist and arm are frequent.

The surgeon operates with magnifying glasses on tissues that have been drained of blood by the tourniquet, to better recognize the structures. Incisions are chosen in accordance with the principles of plastic surgery, to avoid the formation of an embarrassing scar. Wherever possible, incisions are kept to a minimum, and the least invasive methods are favored.

Despite all precautions, problems may arise during or after an operation.

The following information relates to hand surgery in general and is not exhaustive; each individual case may require further explanation. Your surgeon will be happy to answer any questions you may have, so please do not hesitate to ask.

Nerve lesions
Cutting a few nerve fibers with a scalpel can result in insensitivity in the corresponding innervation territory. Simple traction on a nerve can have a similar effect, lasting from a few days to a few weeks. The surgeon strives to avoid such damage. If he accidentally cuts an important nerve and realizes it, he will repair it immediately, using a microsurgical technique; if such a lesion is established secondarily, it may require further intervention. These are risks inherent to hand surgery, whose anatomy is complex and rich in nerves, some of them very small.

Wound healing
The skin heals in 10-14 days, during which time it is protected by a bandage. If the dressing becomes wet, it must be removed, the wound disinfected and a new one applied. Healing then continues for several weeks, or even months. It escapes medical control, and is known as red scarring. Treatment with creams, ultrasound, massage and protection from the sun’s rays. Subsequently, scars evolve, the collagen fibers that form them change, and the scar becomes lighter and more supple.

This evolution varies greatly from one person to the next, and depends above all on the genetic factors inherent in each individual.

Complications such as wound dehiscence, thread loosening and superficial infection are medically manageable and rarely leave any long-term sequelae. These complications are part of the risks inherent in any surgery.

Phlebitis following catheter placement or intravenous injections is rare and easily treated. However, they may cause pain for a few weeks.

Infections
Although every precaution is taken, infection is always a possibility (risk 1/2000 for clean hand surgery, according to our own statistics). This is due to the penetration of a bacterial agent into the wound. These bacteria can originate from the host’s skin (deep pores, nail folds), be carried by the host’s blood from a distant source of infection (e.g. dental abscess, sinusitis, cystitis, etc.), or come from the ambient air, poorly sterilized instruments or a possible lack of asepsis. Our professional teams are trained to prevent them, before, during and after any procedure.

Depending on the stage and extent of the infection, treatment consists of oral or intravenous antibiotics, immobilization of the infected area (plaster cast or splint), and possibly surgery to clean and drain the infection. Pulsatile pain and fever are the first signs of infection; it’s always best to consult us if you have any doubts, as infections that are not recognized until later are always more difficult to treat, and may lead to more severe after-effects.

Hematomas and ecchymosis
This is a local blood effusion in the operated area, either superficial (ecchymosis) or deeper and collected (hematoma). Although bleeding is controlled during the operation by ligatures or electrocoagulation, it can still occur secondarily during the first movements or when the tourniquet is released. Depending on the extent of the surgery, one or more drains may be inserted at the end of the operation, and removed after a few hours, up to a maximum of 48 hours. Hematomas must be evacuated. Bruises resolve spontaneously in around 2-3 weeks.

Pain
Operations, particularly on joints and nerves, can lead to pain in the medium to long term, requiring specific rehabilitation treatments with our specialist occupational therapists, sometimes infiltrations and in some cases a further operation. We do our utmost to ensure that post-operative pain is kept to a minimum, by treating the tissues with care, reducing the duration of the operation and tourniquet as far as possible, and minimizing the risk of edema, which is often a source of pain.

The recommendations given to each patient before he or she returns home play an important role in preventing pain, and must be scrupulously followed, as must taking the medication prescribed by the surgeon.

Algodystrophy (or complex regional pain syndrome or Südeck’s disease)
This is a (largely unexplained) dysfunction of the neurovegetative regulatory system, with an inflammatory reaction disproportionate to its primary cause; it can occur following any trauma, such as a fracture, and also after surgery.

It manifests itself in severe swelling and stabbing pain, usually involving the whole hand (even if the injury or operation initially affected just one finger), and gradually leads to joint stiffness. The course of the disease is long, lasting up to one or two years, with disabling after-effects. It is therefore important to recognize the first symptoms and treat them early, with appropriate medication and intensive occupational therapy to prevent stiffness.

The best thing to do, of course, is to avoid them in the first place. To prevent it, plaster casts and dressings must be comfortable and not too tight (don’t hesitate to come forward quickly if this is the case), and pain and oedema (tissue swelling) must be minimized. In this respect, the recommendations for elevation and mobilization given to you after each operation play a definite preventive role and must be scrupulously followed.

Joint stiffness
This is a (largely unexplained) dysfunction of the neurovegetative regulatory system, with an inflammatory reaction disproportionate to its primary cause; it can occur following any trauma, such as a fracture, and also after surgery.