Benefits and harms of surgery

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Luckily, most patients with a hand injury don’t need surgery. But sometimes it is unavoidable or will likely give the best result. 

Before having an operation, it is important to talk about the benefits and harms

This is a very personal conversation. A patient’s own state of affairs will affect how they feel about surgery and what they stand to gain.

The benefits of surgery are usually to speed up healing, get better hand function and  perhaps the appearance. The common harms are laid out below. 

More detailed benefits and harms are discussed in the hand injury pages.

During the operation

A tourniquet is a tight band placed around the arm to cut off the blood supply. This gives a bloodless field for operating. Not all operations use a tourniquet. There is a small risk of nerve injury and skin injury.

It is possible to unintentionally injure other structures during the operation.

For instance, when repairing a tendon, a nearby nerve might be squashed or cut.

Bleeding is usually easy to stop as the blood vessels are small and easy to seal.

Early after the operation

– during the operation small blood vessels in the skin and tissues might be cut
– the blood vessels are sealed but there is a risk of them opening up after the operation
– bleeding is usually minimal and can be stopped with elevation and pressure

– bacteria enter the wound or deeper tissues
– multiplication of the bacteria cause a wound infection 
– a wound infection is usually treated with antibiotics but can delay healing or need an operation

– a skin wound usually takes 1-2 weeks to heal
– patient factors, such as diabetes and smoking, and surgical factors, such as a tight closure or infection can slow the healing process
– delayed wound healing might cause more discomfort and pain, need trips to a GP or hospital and slow the recovery of hand function

Early failure of the operation is when the operation does not achieve the intended goal or goes wrong not long after the operation. 

For instance, a tendon repair coming apart early after the operation would be a failure.

Failure might lead to a further operation or a worse outcome than expected.

Any of the harms above could lead to the need for another operation, possibly as an emergency.

Later after the operation

– skin wounds or surgical incisions always leave a scar. 
– rather than fading and flattening, some scars become raised (hypertrophic) or enlarged and spread beyond the initial scar (keloid scar). 
– the abnormal scarring can reduce use of the hand and give a poor appearance.

– similar to ‘early failure of procedure’ but further down the line. 
– may result in a poor recovery or need for another operation

– CRPS is usually triggered by an injury or operation. 
– Patients might experience intense pain, swelling and fluctuations in skin colour and temperature in the affected hand.
– treatment involves pain relief, hand therapy and support. Further information is available here.

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