Skin Cancer Scar Revision Hand Surgery

Skin Cancer Scar Revision Hand Surgery2018-07-01T11:54:11+00:00

Skin Cancer/Skin Lesion Removal

Plastic surgery removal of skin cancer, moles, “atypical” moles, lipomas, cysts, and almost all other skin and connective tissue lesions

Skin Cancer

Skin Lesion/Skin Cancer Removal

Click here for more information about Scar Revision

Click here for more information about Hand Surgery

What is a Skin Lesion/Skin Cancer Removal surgical procedure?

Skin Lesion Removal is a surgical procedure that involves the removal of an abnormal, benign or cancerous lesion within the skin.

What part of the Body does the Procedure involve?

  • The part of the body involved in the Skin Lesion Removal procedure depends on the location of the abnormal growth on skin
  • Typically, such skin growths include possible skin cancers, irregular pigmented and non-pigmented lesions, atypical moles, and soft tissue nodules such as lipomas and cysts

Why is the Skin Lesion Removal surgical procedure Performed?

A Skin Lesion Removal procedure is performed for the following reasons:

  • To diagnose a growth abnormality on skin
  • Removal of a suspected cancerous lesion on the skin
  • Removal of a pigmented and/or non-pigmented lesion that may be changing or has an atypical appearance
  • There is a family history of skin cancer
  • There is a bothersome connective tissue growth
  • Cosmetic issues: Individuals concerned about their visual appearance
  • Chronic irritation of the skin due to the lesion
  • Allergic skin conditions
  • Autoimmune disorders affecting the skin
  • Infection of skin

What are some Alternative Choices for the Procedure?

In some cases, freezing a wart  and/or actinic keratosis (cryotherapy) may be performed instead of removing it. Some superficial lesions may be shaved.  However, for many skin tumors, the Skin Lesion Removal surgical procedure is a gold standard procedure.

Common Skin lesions to be removed:

Skin Cancer

Pigmented and Non-pigmented lesions of the skin

Skin Cancer

Epidermoid Inclusion Cysts

Skin Cancer

Lipomas (Localized fat deposits)

What is skin cancer/skin lesion removal?

A cancer diagnosis is very difficult to accept. Understanding that treating your skin cancer may result in scars or disfigurement can also be troubling. Your plastic surgeon understands your concerns and will guide you through treatment and explain the resulting effect on your health and appearance.

Skin cancer, much like any form of cancer, may require surgery to remove the cancerous growth. Your plastic surgeon can surgically remove cancerous and other skin lesions using specialized techniques to preserve your health and your appearance.

ATYPICAL MOLES are unusual-looking benign (noncancerous) moles, also known as dysplastic nevi (the plural of “nevus,” or mole). Atypical moles may resemble melanoma, and people who have them are at increased risk of developing melanoma in a mole or elsewhere on the body. The atypical changes are typically graded as mild, moderate, and/or severe.  The higher the number of these moles someone has, the higher the risk. Those who have 10 or more have 12 times the risk of developing melanoma compared with the general population.

Although no surgery is without scars, your plastic surgeon will make every effort to treat your skin cancer without dramatically changing your appearance.

Skin cancer and skin lesion removal and health insurance

Your health insurance plan should cover skin cancer surgery, related complications or another surgery to reconstruct your appearance.  The removal of most other pigmented and non-pigmented skin lesions, and soft tissue growths (cysts, lipomas, etc.) are likely covered services, especially if there have been recent changes (such as enlarging or becoming darker and/or irregular), producing symptoms such as discomfort and/or numbness, there is a family history of skin cancer and/or melanoma, and the lesion is located in a delicate area such as the nose and/or eyelid.

Pre-certification may be required for reimbursement or coverage. Michael P. Vincent MD FACS , Brent C. Faulkner MD, and our facility participate with almost all health insurance plans and will verify this for you and submit all appropriate paperwork.

Skin cancer and Skin Lesion removal recovery

During your skin cancer removal surgery recovery, incision sites may be sore, red or drain small amounts of fluid.

  • It is important to follow all wound care instructions such as cleansing and applying topical medications exactly as directed
  • You will be able to return to light activity as instructed by your surgeon
  • Typically, it is best to not get the surgical site wet for 24-48 hours.  Your surgeon will specify this for you
  • Make certain to keep your incision sites clean and well protected from potential injury
  • Try to limit movement that may stress your wound and your sutures

Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period.

  • What medication will I be given or prescribed after surgery?
  • Will I have dressings/bandages after surgery?
  • When will they be removed?
  • Are stitches removed? When?
  • When can I resume normal activity and exercise?
  • When do I return for follow-up care?
  • How long will it take before healing is complete?

Healing will continue for many weeks or months as incision lines continue to improve.

It may take a year or more following a given procedure for incision lines to refine and fade to some degree. In some cases, secondary procedures may be required to complete or refine your reconstruction.

Sun exposure to healing wounds may result in irregular pigmentation and scars that can become raised, red or dark. Sun exposure may increase the risk of the development of skin cancer in another region of your body.

Skin cancer removal results

Your plastic surgeon can treat your skin cancer by surgically removing cancerous skin and closing the resulting wound. Some forms of skin cancer require additional treatment such as radiation therapy.

Your physician will advise you about any follow-up treatment recommendations.

Reconstruction closes the skin cancer defect, but no reconstruction is perfect. Visible scars will always remain at incision sites. You may also see textural, color or other visible differences of the skin in reconstructed areas.

In some cases, treating your skin cancer can be disfiguring to your appearance.

Although every effort is made to restore your appearance as closely and naturally as possible, the most important factor is that your skin cancer is effectively removed.

Following your physician’s instructions is essential to the success of your surgery. It’s important that the surgical incisions are not subjected to excessive force, swelling, abrasion or motion during the time of healing.

Your doctor will give you specific instructions on how to care for yourself.

What is the Consent Process before the Procedure?

Our plastic surgeons  will request your consent for Skin Lesion Removal procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

Skin cancer removal procedure steps

Depending on the size, type and location of the lesion, there are many ways to remove skin cancer and reconstruct your appearance if necessary.

The following are some of the possible procedure steps involved in skin cancer removal surgery:

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedures. The choices include local, intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Step 2 – Removal

A small or contained lesion may be removed with excision – a simple surgical process to remove the lesion from the skin. Closure is most often performed in conjunction with excision.

Skin Cancer

Skin cancer can be like an iceberg. What is visible on the skin surface sometimes is only a small portion of the growth.

Beneath the skin, the cancerous cells cover a much larger region and there are no defined borders. In these cases, your plastic surgeon may use frozen sections during the removal of your skin cancer to discover and define the borders of the cancerous area. Frozen sections are small parts of the tissue that are removed and immediately sent to the pathologist. These pieces of tissue are then quickly frozen so that he or she can examine them for cancer cells at the time of removal of the cancer. This helps your plastic surgeon to make sure that all of the cancer has been removed.

Alternatively, your plastic surgeon may recommend a specialized technique called Mohs surgery. This procedure may be performed by your plastic surgeon, or you may be referred to a surgeon that specializes in this procedure.

Step 3 – Reconstruction

A skin cancer lesion that is particularly large, is being removed with frozen sections or is likely to cause disfigurement may be reconstructed with a local flap.

Healthy, adjacent tissue is repositioned over the wound. The suture line is positioned to follow the natural creases and curves of the face if possible, to minimize the obviousness of the resulting scar.

Skin Cancer

Your surgeon may choose to treat your wound with a skin graft instead of a local flap. A skin graft is a thin bit of skin removed from one area of the body and relocated to the wound site.

Step 4 – See the results

After your skin cancer has been removed and any primary reconstruction is completed, a dressing or bandages will be applied to your incisions.

Skin cancer and Skin lesion removal risks and safety

You will have to decide if the risks and potential complications of skin cancer removal surgery are acceptable.

You will be asked to sign consent forms to ensure that you fully understand the procedure.

The risks include:

  • Allergies to tape, suture materials and glues, blood products, topical preparations or injected agents
  • Anesthesia risks
  • Excessive bleeding
  • Change in skin sensation
  • Damage to deeper structures – such as nerves, blood vessels and muscles – can occur and may be temporary or permanent
  • Infection
  • Poor healing of incisions
  • Possibility of revision surgery
  • Recurrence of skin cancer
  • Systemic spread of skin cancer
  • Suboptimal scarring

These risks and others will be fully discussed prior to your consent. It’s important that you address all your questions directly with your plastic surgeon.

Skin graft risks

Skin grafts have an added risk that the graft may not “take” and therefore additional surgery may be necessary to close the wound.  Fortunately, the use of skin grafts is rare

Preserve your health

Once you have been diagnosed with skin cancer, you are at a higher risk to develop another skin cancer. Skin cancer may reoccur. So, it’s important to discuss the signs of skin cancer with your physician, regularly perform self-examinations for suspicious lesions and schedule an annual skin cancer screening.

Skin cancer and Skin lesion removal cost

Skin cancer removal cost varies.  A surgeon’s cost for skin cancer removal surgery may be based on his or her experience, the type of procedure used and the geographic location of the office.  Since our practice and facility participate with almost all health insurance plans, these fees have been set by your plan.  Each plan may have a deductible and/or copay.

Skin cancer removal costs may include:

  • Anesthesia fees (Rare)
  • Hospital (rare) or surgical facility costs
  • Medical tests (Most specimens are forwarded for Pathology)
  • Prescriptions for medication (Rare)
  • Surgeon’s fee (Set by your health insurance plan)

When choosing a board-certified plastic surgeon for skin cancer removal surgery, remember that the surgeon’s experience and your comfort with him or her are just as important as the final cost of the surgery.

Do you need a Second Opinion prior to the Skin Cancer or Skin Lesion Removal Procedure?

  • It is normal for a patient to feel uncomfortable and confused by the information regarding Skin Lesion Removal and on what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
  • Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

Choose a plastic surgeon you can trust

Skin cancer surgery involves many choices. The first and most important is selecting a board-certified plastic surgeon you can trust who is a member of the American Society of Plastic Surgeons (ASPS).

ASPS member surgeons meet rigorous standards:

  • Board certification by the American Board of Plastic Surgery® (ABPS) or in Canada by the Royal College of Physicians and Surgeons of Canada®
  • Complete at least six years of surgical training following medical school with a minimum of three years of plastic surgery residency training
  • Pass comprehensive oral and written exams
  • Graduate from an accredited medical school
  • Complete continuing medical education, including patient safety, each year
  • Perform surgery in accredited, state-licensed, or Medicare-certified surgical facilities

Do not be confused by other official-sounding boards and certifications.

The ABPS is recognized by the American Board of Medical Specialties (ABMS), which has approved medical specialty boards since 1934. There is no ABMS recognized certifying board with “cosmetic surgery” in its name.

By choosing a member of the American Society of Plastic Surgeons, you can be assured that you are choosing a qualified, highly-trained plastic surgeon who is board-certified by the ABPS or the Royal College of Physicians and Surgeons of Canada.

Photos and illustrations are examples and are meant to be helpful, informative, and educational.  No implicit guarantees regarding similar results can be given.  Additional information and the above text can be found on the ASPS website.

Plastic Surgery Scar Revision

Skin Cancer Scar Revision

What is scar revision?

Scar revision surgery will attempt to minimize a scar so that it is less conspicuous and blends in with the surrounding skin tone and texture.

Scars are visible signs that remain after a wound has healed. They are the unavoidable results of injury or surgery, and their development can be unpredictable. Poor healing may contribute to scars that are obvious, unsightly or disfiguring. Even a wound that heals well can result in a scar that affects your appearance. Scars may be noticeable due to their size, shape or location; they can also be raised or depressed, and may differ in color or texture from the surrounding healthy tissue.

Your treatment options may vary based on the type and degree of scarring and can include:

  • Simple topical treatments
  • Minimally invasive procedures such as scar injections
  • Surgical revision with advanced techniques in wound closure

Although scar revision can provide a more pleasing cosmetic result or improve a scar that has healed poorly, a scar cannot be completely erased.

What is a scar?

Scar revision is plastic surgery performed to improve the condition or appearance of a scar (possibly following trauma or major skin cancer surgery) anywhere on your body. The different types of scars include:

Discoloration or surface irregularities and other more subtle scars can be cosmetically improved by surgery or other treatments recommended by your plastic surgeon. These types of scars do not impair function or cause physical discomfort and include acne scars as well as scars resulting from minor injury and prior surgical incisions.

Skin Cancer

Hypertropic scars are thick clusters of scar tissue that develop directly at a wound site. They are often raised, red and/or uncomfortable and may become wider over time. They can be hyperpigmented (darker in color) or hypopigmented (lighter in color).

Skin Cancer Scar

Keloids are larger than hypertropic scars. They can be painful or itchy, and may also pucker. They extend beyond the edges of an original wound or incision. Keloids can occur anywhere on your body, but they develop more commonly where there is little underlying fatty tissue, such as on the face, neck, ears, chest or shoulders.

Skin Cancer Scar

Contractures are scars that restrict movement due to skin and underlying tissue that pull together during healing. They can occur when there is a large amount of tissue loss, such as after a burn. Contractures also can form where a wound crosses a joint, restricting movement of the fingers, elbows, knees or neck.

Skin Cancer Scar

The type of scar you have will determine the appropriate techniques your plastic surgeon will use to improve your scar.

Who is a good candidate for scar revision?

Scar revision is a highly individualized procedure and you should do it for yourself, not to fulfill someone else’s desires or to try to fit any sort of ideal image.

Scar revision can be performed on people of any age and is a good option for you if:

  • You are bothered by a scar anywhere on your body
  • You are physically healthy
  • You do not smoke
  • You have a positive outlook and realistic goals for your scar revision surgery
  • You do not have active acne or other skin diseases in the area to be treated

What is the cost of scar revision?

Cost is always a consideration in elective surgery. Prices for scar revision procedures can vary. A surgeon’s cost for scar revision may vary based on his or her experience, the type of procedure used, as well as geographic location.  Michael P. Vincent MD FACS and Brent C. Faulkner MD, and our facility participate with almost all health insurance plans and our office will be glad to check the pre-certification requirements of your health plan.

Many plastic surgeons offer patient financing plans for scar revision, so be sure to ask.  Our practice participates with CareCredit.

Scar revision costs may include:

  • Surgeon’s fee
  • Hospital (rare) or surgical facility costs
  • Anesthesia fees (less common)
  • Prescriptions for medication
  • Post-surgery garments
  • Medical tests (rare)

Most health insurance plans will not cover scar revision surgery if done for purely cosmetic reasons.   Our office will help you with this distinction.

Your satisfaction involves more than a fee. When choosing a plastic surgeon for scar revision surgery, remember that the surgeon’s experience and your comfort with him or her are just as important as the final cost of the surgery.

What should I expect during a consultation for scar revision?

The success and safety of your scar revision procedure depends very much on your complete candidness during your consultation. You’ll be asked a number of questions about your health, desires and lifestyle.

During your scar revision consultation be prepared to discuss:

  • Why you want the surgery, your expectations and desired outcome
  • Medical conditions, drug allergies and medical treatments
  • Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
  • Previous surgeries

Your surgeon will also:

  • Evaluate your general health status and any pre-existing health conditions or risk factors
  • Examine your scar in detail
  • Is the scar secondary to trauma, major skin cancer surgery, or some other issue
  • Take photographs for your medical record
  • Discuss your options and recommend a course of treatment
  • Discuss likely outcomes and any risks or potential complications

What questions should I ask my plastic surgeon about scar revision?

Use this checklist as a guide during your scar revision consultation:

  • Are you certified by the American Board of Plastic Surgery?
  • Were you trained specifically in the field of plastic surgery?
  • How many years of plastic surgery training have you had?
  • Do you have hospital privileges to perform this procedure? If so, at which hospitals?
  • Is the office-based surgical facility accredited by a nationally- or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?
  • How many procedures of this type have you performed?
  • Am I a good candidate for this procedure?
  • Where and how will you perform my procedure?
  • How long of a recovery period can I expect, and what kind of help will I need during my recovery?
  • What are the risks and complications associated with my procedure?
  • How are complications handled?
  • What are my options if I am dissatisfied with the cosmetic outcome of my scar revision surgery?
  • Do you have before-and-after photos I can look at for each procedure and what results are reasonable for me?

What are the risks of scar revision?

The decision to have scar revision surgery is extremely personal and you’ll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable. Your plastic surgeon and/or staff will explain in detail the risks associated with surgery.

You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo, the alternatives and the most likely risks and potential complications.

Scar revision risks include:

  • Bleeding (hematoma)
  • Infection
  • Delayed healing
  • Anesthesia risks
  • Change in skin sensation
  • Damage to deeper structures including nerves, blood vessels, muscles and lungs can occur and may be temporary or permanent
  • Allergies to tape, suture materials and glues, blood products, topical preparations or injected agents
  • Skin contour irregularities
  • Skin discoloration and swelling
  • Skin sensitivity
  • Deep vein thrombosis, cardiac and pulmonary complications
  • Pain, which may persist
  • Disappointment
  • The potential need for additional surgical procedures or staged procedures
  • No improvement or the very rare potential of making a scar worse

Be sure to ask questions: It’s very important to ask your plastic surgeon questions about your procedure. It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings with your plastic surgeon.

Where will my surgery be performed?

Scar revision surgery may be performed in your plastic surgeon’s office, accredited office-based surgical facility, an ambulatory surgical facility or a hospital. Your plastic surgeon and the assisting staff will fully attend to your comfort and safety.

When your procedure is finished, bandages or dressings may be applied to keep the surgical site clean.

You will be given specific instructions that may include: How to care for yourself following surgery, medications to apply or take orally to aid healing and reduce the risk of infection and when to follow-up with your plastic surgeon.

When you go home

If you experience shortness of breath, chest pains or unusual heartbeats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment.

Be careful

Following your physician’s instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself.

Follow all postoperative instructions carefully, including cleansing and at-home treatment regimens, and avoid sun exposure. Your cooperation will influence the outcome of your surgery.

How should I prepare for scar revision surgery?

Prior to scar revision surgery, you may be asked to:

  • Get lab testing or a medical evaluation
  • Take certain medications or adjust your current medications
  • Stop smoking well in advance of surgery
  • Avoid taking aspirin and certain anti-inflammatory drugs and herbal supplements as they can increase bleeding

Special instructions you receive will cover:

  • What to do on the day of surgery
  • The use of anesthesia during your procedure
  • Post-operative care and follow-up

What are the steps of a scar revision procedure?

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedures. The choices include local anesthesia, intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Step 2 – The treatment

The degree of improvement that can be achieved with scar revision will depend on the severity of your scarring, and the type, size and location of the scar. In some cases, a single technique may provide significant improvement. However, your plastic surgeon may recommend a combination of scar revision techniques to achieve the best results.

Topical treatments, such as gels, tapes or external compression, can help in wound closure and healing, or to reduce the ability of skin to produce irregular pigment. These products may be used to treat existing surface scars and discoloration, and to aid in the healing of scar revision procedures.

Injectable treatments may also be used. Dermal filler can be used to fill depressed or concave scars. Depending on the injectable substance used and your particular scar conditions, results may last from three months to several years. Therapy must be repeated to maintain results. Another form of injection therapy uses steroidal-based compounds to reduce collagen formation and can alter the appearance, size and texture of raised scar tissue.

Skin Cacner Scar Revision

Surface treatments are most often used for cosmetic improvement of scars. These methods can soften surface irregularities and reduce uneven pigmentation. Surface treatments are a controlled means of either mechanically removing the top layers of skin or changing the nature of tissue. These treatment options include:

  • Dermabrasion is a mechanical polishing of the skin.
  • Laser or light therapy causes changes to the surface of the skin that allow new, healthy skin to form at the scar site.
  • Chemical peel solutions penetrate the skin’s surface to soften irregularities in texture and color.
  • Skin bleaching agents are medications applied topically to lighten the skin.

Skin Cancer Revision

Step 3 – Sometimes for deeper scars an incision is needed to surgically remove the old scar

Skin Cancer Scar

Step 4 – Closing the incisions

Some scars require layered closure. Layered closure is often used where excision extends to tissue below the skin surface or in areas with a high degree of movement. The first step, or layer, requires sub-dermal closure (below the skin surface) with absorbable or non-removable sutures. Layers of closure continue to build, concluding with closure of the remaining surface wound.

Advanced techniques in scar revision include complex flap closures and W-plasty or Z-plasty techniques. Flap closures may reposition a scar so that it is less conspicuous or improve flexibility where contracture has restricted mobility.

If the scar revision is performed in an area of prior skin cancer, the tissue may be forwarded to Pathology.

What should I expect during my scar revision recovery?

Progress and healing

The initial healing phase of a surgical scar revision may include localized swelling, discoloration or discomfort and may take 1 to 2 weeks. Healing will continue for several weeks and as the new scar heals it will slowly refine and fade. With dermabrasion, chemical peel or laser resurfacing, you will experience similar conditions at the treated area, in addition to overall sensitivity.

The results will be long-lasting

Skin Cancer

Scar Revision of upper lip and Cheek

Skin Cancer

Scar Revision of Medial Cheek

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Scar Revision of Cheek

The final results of your scar revision surgery will be long-lasting, however it may take several months for your final results to become apparent and in some cases it may take a year for the new scar to fully heal and fade.

The practice of medicine and surgery is not an exact science. Although good results are expected, there are no guarantees; and in some situations, it may not be possible to achieve optimal results with a single surgical procedure and another surgery may be necessary.

Hand Surgery

Skin Cancer

What is hand surgery?

If your hand is impaired in any way, surgery may improve your condition. This type of very specialized surgery can treat diseases that cause pain and impair the strength, function and flexibility of your wrist and fingers. Surgery seeks to restore to near normal the function of fingers and hands injured by trauma or to correct abnormalities that were present at birth.  Hand surgery is an integral part of the plastic surgeons’s training.

What hand surgery can treat

Skin and soft tissue tumors/growths of the hand:  This includes the removal of most skin and connective tissue nodules and/or growths including skin cancer, moles, other pigmented lesions, ganglion cysts of the hand, digital cysts of the fingers, and benign tumors like giant cell tumors and lipomas.

Skin Cancer Page

Ganglion cyst of hand/wrist

Skin Cancer Page

Soft tissue growths of hand and fingers

Skin Cancer Page

Digital cysts of fingers

Carpal tunnel syndrome: A condition caused by pressure to the median nerve within the wrist, or carpal tunnel. You might feel pain, a tingling sensation, numbness of the fingers, weakness or aching. Carpal tunnel syndrome is associated with multiple conditions including: repetitive motion or overuse, fluid retention during pregnancy, injury to the nerve in the carpal tunnel or rheumatoid arthritis.  Carpal tunnel release involves releasing the overlying ligamentous tissue that is compressing the median nerve in order to alleviate the pain and numbness associated with carpal tunnel syndrome.  This can be performed by the traditional “open” approach or an endoscopic approach.

Skin Cancer Page  Skin Cancer Page

Dupuytren’s contracture: A potentiallly disabling hand disorder in which thick, scar-like tissue bands form within the palm and may extend into the fingers. It can cause restricted movement, bending the fingers into an abnormal position.  Injections using XIAFLEX® (collagenase clostridium histolyticum) may prove helpful in some cases.

Skin Cancer Page

Trigger finger release: Trigger finger is a painful condition that causes the fingers or thumb to catch or lock when bent. In the thumb its called trigger thumb.

Trigger finger happens when tendons in the finger or thumb become inflamed. Tendons are tough bands of tissue that connect muscles and bones. Together, the tendons and muscles in the hands and arms bend and straighten the fingers and thumbs.

A tendon usually glides easily through the tissue that covers it (called a sheath) because of a lubricating membrane surrounding the joint called the synovium. Sometimes a tendon may become inflamed and swollen. Prolonged irritation of the tendon sheath can produce scarring and thickening that impede the tendon’s motion. When this happens, bending the finger or thumb can pull the inflamed tendon through a narrowed tendon sheath, making it snap or pop.

Skin cancer

Triggering of Ring Finger requiring surgical release of overlying Pulley

Rheumatoid arthritis: A disabling disease that can cause severe inflammation in any joint of the body. In the hand, it can deform fingers, cause pain and impair movement.

Hand surgery candidates

Patients with painful conditions like carpal tunnel syndrome, rheumatoid arthritis and Dupuytren’s contracture may be suitable candidates for hand surgery.

These procedures can be performed on people of any age and is a good option for you if:

  • You do not have additional medical conditions or other illnesses that may impair healing
  • You are a nonsmoker
  • You have a positive outlook and realistic goals for your hand surgery
  • You are committed to following your plastic surgeon’s prescribed course of treatment

In some conditions, hand surgery is necessary to treat wounds and injuries. Plastic surgeons are often involved in treating patients who come to the emergency room with severe hand trauma.

Hand surgery recovery

After surgery, bandages or dressings may be applied to keep the surgical site clean and splints may be used when needed.

You will be given specific instructions that may include: How to care for your hand(s) following surgery, medications to apply or take orally to aid healing and reduce the risk of infection and when to follow-up with your plastic surgeon.  Strict elevation of the operated hand is crucial in the postoperative period.

Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period.

  • Where will I be taken after my surgery is complete?
  • What medication will I be given or prescribed after surgery?
  • Will I have dressings/bandages after surgery? When will they be removed?
  • Are stitches removed? When?
  • When can I resume normal activity and exercise?
  • When do I return for follow-up care?

Follow all postoperative instructions including cleansing, taking prescribed medications and hand therapy exercises. Therapy is critical to restoring strength, flexibility and movement. If you attempt to return to normal function too soon, the risk of re-injury is possible. Continue your hand therapy regimen and attend follow-up visits with your plastic surgeon as scheduled. This is essential to a successful outcome.

The end result of your hand surgery is directly related to following your therapist’s and plastic surgeon’s instructions.

Hand surgery results

The final outcome of your hand surgery will develop over time. While advances in hand surgery can accomplish near miracles in reconstruction and replantation, your outcome cannot be fully predicted. For certain traumatic injuries, it may not be possible to achieve completely normal function.

If you had surgery to correct carpal tunnel syndrome, modifying work habits as recommended is vital to long-term improvement. Your final outcome may not be realized for several months. If your procedure involved microsurgery, a year is considered appropriate to fully reach restored function.

Hand surgery procedure steps

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedures. The choices include local anesthesia, intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Step 2 – The incision

Treating trauma

The most common traumatic hand or finger injury requiring hand surgery is tendon repair. When a tendon is cut, it will retract from the original wound site. Tendon repair retrieves the retracted tendon and reconnects it using surgical techniques to restore function and movement.

Skin Cancer

Carpal tunnel syndrome relief

Pressure on the median nerve in the carpal tunnel must be relieved to repair this condition. An incision is made from the middle of the palm to the wrist, allowing access to the constricted tissue causing pressure on the nerve. An alternate procedure is referred to as an endoscopic carpal tunnel release, with smaller incisions (see blue dotted lines) and the use of a surgical microscope or endoscope, a small flexible tube that contains a light and lens, to release pressure.

Skin Cancer

Birth deformities can be repaired

When fingers are fused together at birth, called syndactyly, they may be joined only by a web of skin or by skin and a partial fusion of bones. Surgery involves separating the two fingers to provide a full range of motion and a normal appearance, as well as permitting more normal finger growth. Techniques such as skin grafting or a local flap procedure like Z-plasty create flexibility at the incision site for growth and movement of the fingers.

Skin Cancer

Your plastic surgeon may recommend one or a combination of techniques to achieve your goals. Some of those techniques include: microsurgery, grafting of skin, bone, nerves or other tissue from healthy parts of the body, z-plasty and physical therapy.

Step 3 – Closing the incisions

Depending on your condition and type of treatment you may have incisions that need to be closed with removable sutures or your plastic surgeon may use non-removable sutures.

Step 4 – See the results

The results of hand surgery will appear gradually as swelling subsides. Your final outcome may not be realized for several months.

Hand surgery risks and safety

The decision to have hand surgery is extremely personal and you’ll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable. Your plastic surgeon and/or staff will explain in detail the risks associated with surgery.

You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo, the alternatives and the most likely risks and potential complications from hand surgery.

Possible hand surgery risks include:

  • Bleeding (hematoma)
  • Blood clots
  • Infection
  • Anesthesia risks
  • Unfavorable scarring
  • No improvement
  • Change in skin sensation
  • Skin contour irregularities
  • Skin discoloration/swelling
  • Poor healing of incisions
  • Injury to the blood vessels, nerves or tendons
  • Unexpected hand swelling
  • Allergies to tape, suture materials and glues, blood products, topical preparations or injected agents
  • Deep vein thrombosis, cardiac and pulmonary complications
  • Damage to deeper structures—such as nerves, blood vessels, muscles and lungs—can occur and may be temporary or permanent
  • Pain, which may persist
  • Possibility of revisional surgery

Be sure to ask questions: It’s very important to ask your plastic surgeon questions about your procedure. It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings with your plastic surgeon.

Additional risks associated with these specific surgeries include:

Carpal tunnel

  • Non-improvement
  • Recurrence of carpal tunnel syndrome

Extensor tendon

  • Additional incisions necessary because cut tendons may retract
  • Failure of tendon repair
  • Inability to restore function
  • Tendon scarring

Flexor tendon

  • Additional incisions necessary because cut tendons may retract
  • Inability to restore function
  • Tendon scarring

Tenolysis

  • Abnormal tendon position
  • Additional incisions necessary where scarring occurs or to make new incisions to release scar tissue that is limiting tendon motion
  • Inability to restore function
  • Recurrent tendon scarring
  • Rupture of tendon
  • Seroma (fluid accumulation)
  • Wound breakdown

Trigger finger

  • Non-improvement
  • Tendon scarring

Your hand surgery consultation

The success and safety of your hand procedure depends very much on your complete candidness during your hand surgery consultation. You’ll be asked a number of questions about your health, desires and lifestyle.

During your hand surgery consultation be prepared to discuss:

  • Why you want the procedure, your expectations and desired outcome
  • Medical conditions including a history of skin cancer and/or other hand issues, drug allergies and medical treatments
  • Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
  • Previous surgeries

Your plastic surgeon will also:

  • Evaluate your general health status and any pre-existing health conditions or risk factors
  • Examine your hand in detail
  • Discuss your options and recommend a course of treatment to restore hand function
  • Discuss likely outcomes of hand surgery and any risks or potential complications

Preparing for hand surgery

Prior to hand surgery, you may be asked to:

  • Get lab testing or a medical evaluation
  • Take certain medications or adjust your current medications
  • Stop smoking well in advance of surgery
  • Avoid taking aspirin and certain anti-inflammatory drugs and herbal supplements as they can increase bleeding

Special instructions you receive will cover:

  • What to do on the day of surgery
  • The use of anesthesia during your procedure
  • Post-operative care and follow-up

Your plastic surgeon will also discuss where your procedure will be performed. Depending on the type of surgery you will undergo, your procedure may be performed in your plastic surgeon’s accredited office-based surgical facility, an ambulatory surgical facility or a hospital.

You’ll need help

If your hand surgery is performed on an outpatient basis, be sure to arrange for someone to drive you to and from surgery and to stay with you for at least the first night following surgery.

Hand surgery cost

Cost is always a consideration in surgery, whether to repair your hand or to reconstruct your appearance. A surgeon’s cost for hand surgery may vary based on his or her experience, the type of procedure used, as well as geographic location.  Michael P. Vincent MD FACS and Brent C. Faulkner MD, and our facility participate with almost all health insurance plans, so fees have been predetermined by your health plan.  Each health plan may have its own deductible and copay.  Most hand surgery procedures are covered services by your health plan.

Hand surgery costs may include:

  • Surgeon’s fee
  • Hospital or surgical facility costs
  • Anesthesia fees
  • Prescriptions for medication
  • Post-surgery garments
  • Medical tests

Hand surgery and health insurance

Your health insurance plans will likely cover hand surgery, related complications or another surgery to reconstruct your appearance. Pre-certification is generally required for reimbursement or coverage. Our office will be glad to verify the pre-certification requirements for you.

Your satisfaction involves more than a fee. When choosing a plastic surgeon for hand surgery, remember that the surgeon’s experience and your comfort with him or her are just as important as the final cost of the surgery

Choose a plastic surgeon you can trust

Hand surgery involves many choices. The first and most important is selecting a board-certified plastic surgeon you can trust who is a member of the American Society of Plastic Surgeons (ASPS).

ASPS member surgeons meet rigorous standards:

  • Board certification by the American Board of Plastic Surgery® (ABPS) or in Canada by the Royal College of Physicians and Surgeons of Canada®
  • Complete at least six years of surgical training following medical school with a minimum of three years of plastic surgery residency training
  • Pass comprehensive oral and written exams
  • Graduate from an accredited medical school
  • Complete continuing medical education, including patient safety, each year
  • Perform surgery in accredited, state-licensed, or Medicare-certified surgical facilities

Do not be confused by other official-sounding boards and certifications.

The ABPS is recognized by the American Board of Medical Specialties (ABMS), which has approved medical specialty boards since 1934. There is no ABMS recognized certifying board with “cosmetic surgery” in its name.

By choosing a member of the American Society of Plastic Surgeons, you can be assured that you are choosing a qualified, highly-trained plastic surgeon who is board-certified by the ABPS or the Royal College of Physicians and Surgeons of Canada.

Photographs and illustrations on this page are examples and are meant to be helpful, informative, and educational.  No implicit guarantees regarding similar results can be given.  Additional information and the above text can be found on the ASPS website.

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