How We Treat The Hand: Hand Medicine and Surgery

Hand Surgery is an unusual specialty. Among other things, it is a specialty shared by General Surgery, Orthopedic Surgery and Plastic Surgery, each doing the same things. Also, though officially a surgical  specialty, care of the hand actually involves more medical care than surgery. Care can be divided into several categories, trauma care, arthritis and inflammatory processes, congenital problems, and miscellaneous problems.

Trauma Care

This can be mostly surgical initially, involving repair of cut or injured tendons, muscles, nerves or vessels. However, many injuries do not involve transection of a structure and require only observation and retraining. Even initial surgical repairs require more follow up than most injuries elsewhere because of the necessity of retraining the brain. Many initial repairs may require only minor surgery to achieve later function. Retraining is achieved through cooperation of the patient, a specially trained hand therapist and the doctor.

Arthritis & Inflammatory Processes

This is probably the largest group of problems and the one with the least actual surgical procedures. Rheumatoid arthritis and osteoarthritis are well known problems, but other processes like psoriasis, gout, and autoimmune disease can also cause similar symptoms. Part of all the arthritides is inflammation of the synovium, the tissue surrounding the joints. This tissue also surrounds the tendons and other structures in the hand and arm and can become inflamed without joint problems. Common examples of this is tenosynovitis, trigger finger, De Quervain’s, and, even, carpal tunnel and other nerve compression syndromes. Though many of these, including carpal tunnel, are generally considered surgical problems, medical treatment is actually best.

Congenital Problems

Most of these are, indeed, surgical, to correct the congenital problem. Though Dr. Buchanan did a large numbers of these while at Children’s Hospital in Oklahoma City, he believes these problems generally need to be treated by those who do so frequently.

Miscellaneous

These are almost all other problems that can occur in the hand and upper extremity. Many of these, such as Dupuytren’s contracture have gone from usually surgical to frequently medical. In the case of Dupuytren’s, an injection into the contracting band instead of cutting it essentially melts the scar, releasing the contracture.

The Center for Plastic Surgery & Hand Care

In addition to plastic surgery, Dr. Buchanan is board certified in hand surgery and taught it for many years. He still cares for many patients with hand problems. If you have a problem with your hand or upper extremity, call the Center for Plastic Surgery at 828-526-3783 to learn more or for an appointment.

Three groups of physicians see and evaluate patients with skin cancers, family physicians, dermatologists and plastic surgeons. We as plastic surgeons do so because we treat other skin problems related to sun damage and aging, we are good at excising lesions, and many skin cancers occur on the face and hands, areas where we have significant experience and are asked to treat by the other specialities.

Types of Skin Cancers

There are three main types of skin “cancers.” The least common (fortunately) is melanoma, a true, aggressive cancer of the pigment cells. Next is squamous cell carcinoma, also a true cancer that destroys the local tissue and can spread to other parts of the body. The most common is basal cell, a tumor that destroys local tissue but does not spread except by direct extension. There are also multiple other cancers that can occur on the skin, mostly related to skin appendages like glands or metastatic from other areas. These, however, comprise only about 0.5% of skin cancers.  Each requires different evaluation and treatment.

Evaluation of Skin Cancers

The problem with skin cancers is that they can look like each other or other entities. The first thing that must be done is recognizing what may be a skin cancer. That is where dermatologists and plastic surgeons excel. Once the possibility is recognized the exact nature of the lesion needs to be determined. This is usually accomplished with a biopsy, removing a piece for pathological evaluation. Shaving a piece of the lesion is the most common method of biopsy  This takes a week or 2 to heal with several times a day antibiotic care. We prefer a punch biopsy that takes a small full thickness piece of the lesion. This heals quickly and takes no care, important if the lesion is not a cancer. It is also the best way to sample a melanoma, as lesion thickness is important in determining treatment. Once diagnosed, further tests may be required to decide on treatment, especially if the lesion is melanoma.

Treatment of Skin Cancer

The lesion determines the treatment. We treat basal cells multiple different ways including chemotherapy, freezing, and excision depending on its characteristics. Squamous cell is treated similarly, but more aggressively. Melanoma always requires excision and may also need lymph node biopsy or excision.

If you have a lesion that you are concerned about or know needs treatment, call us at our Highlands, NC office at 828-526-3783.

It may be a controversial topic, but there are many situations in which it’s acceptable for a child to undergo plastic surgery, especially if it’s to correct accidental damage or a congenital deformity. These procedures are done for physical reconstruction and self-confidence issues as opposed to purely cosmetic reasons.

• Accident Reconstruction. Children can be accident prone, and their little bodies can’t take a lot of trauma without some physical scarring. If a child is involved in a car accident, is bitten by a dog, or is seriously wounded by another means, reconstructive plastic surgery can repair the damage.
• Otoplasty: A common surgery among children is the surgical repair or repositioning of the ear, called otoplasty. Many children don’t like the way their ears look, or may have been born with prominent ears, where the ear sticks out from the head. These children may be the targets of bullying by those who can be un-intentionally cruel. Otoplasty is commonly recommended in these instances for the child’s emotional well being.
• Cleft Lip or Cleft Palate: The cleft lip and the cleft palate are two of the most common conditions that can be present at birth. Both can severely hinder eating and speaking, and may affect the way a child feels about how he or she looks. Plastic surgery at a center specializing in this is the only way to repair these conditions, and the results can be life-changing.
• Cosmetic Procedures: For some children or teens, plastic or cosmetic surgery may be an emotionally necessary. The removal of a prominent mole or birthmark may be appropriate in many circumstances.

The availability of pediatric plastic surgery is a blessing for many children. If you have questions or concerns about any of these procedures, we invite you to give us a call at 828-526-3783 to schedule a consultation appointment with Dr. Buchanan.