General information on having an operation on your wrist or hand
As previously stated, not all people with hand and wrist problems will require an operation. In some cases surgery may be discussed and considered and the majority of routine operations are successful, however, it is not the best option for everyone. The following information provides a rough guide to some of the issues that can occur following surgery. It is important that these are taken into consideration before surgery to the wrist and hand is performed.
Wounds
After hand/wrist surgery, all wounds must be kept clean, dry and covered for seven to 12 days. This allows normal wound healing to start and reduces the risk of infection. Once the stitches are removed the wound can be cleaned and left open to the air. You are advised not to soak the wound for two weeks after surgery. During the healing process the wound is tender and often itchy which is completely normal. The wound normally takes a few weeks to heal but it often takes around six to 12 months for scar tissue to settle.
When you have an operation, nerves on the skin surface are always divided in the wound. This can make the skin surface feel numb around the wound which can be permanent. It is very unusual for this to give any major problems, but you should be careful when handling hot or cold objects.
Scar formation
Scar tissue will form as an important part of the healing process. This is the body’s normal reaction to injury or surgery. Scar tissue can sometimes become thick and lumpy and stick to underlying structures and restrict movement. It may also be sensitive to touch. This is normal following surgery and in most cases will settle within two to three months of the operation. Rarely, long-term tenderness is an issue although hypertrophic scar formation can occur. This is a condition in which the scar increases in width and feels lumpy. It can give rise to a cosmetic issue but is not serious. It is very important to start scar management once the wound area has fully healed.
You can also help your scar to heal by eating a balanced diet, especially food rich in vitamins such as milk, yoghurt and green leafy vegetables. Also try and drink lots of water each day unless you have been told not to. Smoking is not advised as it slows down the healing process. Scar tissue can also burn easily so you should stay out of direct sunlight or use total sun block where this cannot be avoided. Massaging your scar regularly each day using a non-perfumed moisturiser will helping to soften and reduce scar tissue and improve sensitivity.
Hand swelling / stiffness
Following surgery swelling is common in the area operated on. Keeping your hand elevated following surgery can help to reduce swelling. It is important to move the hand early and often following hand surgery to avoid stiffness developing in the fingers and wrist. Exercise is also important as it can prevent the scar tissue from tightening and adhering to underlying structures.
Infection
Developing a wound infection occurs in around one in 100 patients following an operation. It is vital that you are aware of the signs of infection following your surgery which includes increased pain and swelling, heat, increased odour, and redness which spreads and tracks up the hand. More severe cases may require antibiotic treatment and occasionally a further operation to clean out the wound but this is very unusual.
Nerve and blood vessels injury
There is a risk of nerve or blood vessel injury when operating on the arm and hand. There are very small nerves in the skin that can be damaged resulting in some altered sensation at the site of the surgical incision. This altered sensation tends to improve over time. Damage to large nerves is rare but may occur if the nerve is stretched or bruised. This can result in altered sensation and occasionally weakness that is usually temporary. Blood vessels can be damaged during surgery however most bleeding stops during surgery or resolves shortly after.
Complex Regional Pain Syndrome (CRPS)
CRPS is a rare but very serious complication following surgery to the hand or arm, affecting one in every 2000 patients. It causes pain, increased sensitivity, swelling and stiffness in the hand which can often take up to two years to improve.
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Working after an operation
Time off work may be required following surgery, depending on the nature of your job. There are no hard rules about this. As a guide, patients with heavy manual jobs may need four to six weeks off work. Patients with office based jobs often return to work within a few days.
Driving
You should not drive after hand surgery until you are fit to do so. It takes time to recover from the effects of the anaesthetic and some painkilling medication prescribed after surgery may affect your fitness to drive. It is advised that you do not drive whilst you have stitches in place. It is your responsibility to ensure that you are in full control of the vehicle. There is detailed information on the DVLA website about fitness to drive and you should refer to that before driving. If you are in any doubt, consult your surgeon or GP as well as your insurance company. Different motor insurers have different policies about medical fitness to drive and you should check that you are fully insured before driving.
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