(A) Hand Surgery :
The field of hand surgery deals with both surgical and non-surgical treatment of conditions and problems that may take place in the hand or upper extremity (commonly from the tip of the hand to the shoulder) including injury and infection. Hand surgery may be practiced by graduates of general surgery, orthopedic surgery and plastic surgery.
Plastic surgeons and orthopedic surgeons receive significant training in hand surgery during their residency training, with some graduates going on to do an additional one year hand fellowship. Board certified general, plastic, or orthopaedic surgeons who have completed approved fellowship training in hand surgery and have met a number of other practice requirements are qualified to take the “Certificate of Added Qualifications in Surgery of the Hand” examination, formerly known as the CAQSH, it is now known as the SOTH.”Regardless of their original field of training, once candidates have completed an approved fellowship in hand surgery, all hand surgeons have received training in treating all injuries both to the bones and soft tissues of the hand and upper extremity. Among those without additional hand training, Plastic surgeons have usually received training to handle traumatic hand and digit amputations that require a “replant” operation. Orthopedic surgeons are trained to reconstruct all aspects to salvage the appendage: tendons,muscle,bone. Orthopedic surgeons are trained to handle complex fractures of the hand and injuries to the carpal bones that alter the mechanics of the wrist.
The following conditions can be indications for hand surgery:
- Hand injuries
- Carpal tunnel syndrome
- Carpometacarpal bossing
- Rheumatoid arthritis
- Dupuytren’s contracture
- Congenital defects
(B) Plastic Surgery :
Plastic surgery is a medical specialty concerned with the “correction” or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, plastic surgery is not necessarily cosmetic; and includes many types of Reconstructive surgery, Craniofacial sugery, Hand surgery, Microsurgery, and the treatment of burns.
Techniques & Pro-procedures :
In plastic surgery, the transfer of skin tissue (skin grafting) is a very common procedure. Skin grafts can be taken from the recipient or donors:
- Autografts are taken from the recipient. If absent or deficient of natural tissue, alternatives can be cultured sheets of epithelial cells in vitro or synthetic compounds, such as integra, which consists of silicone and bovine tendon collagen with glycosaminoglycans.
- Allografts are taken from a donor of the same species.
- Xenografts are taken from a donor of a different species.
Usually, good results are expected from plastic surgery that emphasizes careful planning of incisions so that they fall in the line of natural skin folds or lines, appropriate choice of wound closure, use of best available suture materials, and early removal of exposed sutures so that the wound is held closed by buried sutures.
Sub disciplines of plastic surgery may include :
- Aesthetic Surgery :Aesthetic surgery is an essential component of plastic surgery and includes facial and body aesthetic surgery. Plastic surgeons use cosmetic surgical principles in all reconstructive surgical procedures as well as isolated operations to improve overall appearance.
- Burn Surgery :Burn surgery generally takes place in two phases. Acute burn surgery is the treatment immediately after a burn. Reconstructive burn surgery takes place after the burn wounds have healed.
- Craniofacial Surgery :Craniofacial Surgery is divided into pediatric and adult craniofacial surgery. Pediatric craniofacial surgery mostly revolves around the treatment of congenital anomalies of the craniofacial skeleton and soft tissues, such as cleft lip and palate, craniosynostosis, and pediatric fractures. Adult craniofacial surgery deals mostly with fractures and secondary surgeries (such as orbital reconstruction) along with orthognathic surgery. Craniofacial surgery is an important part of all plastic surgery training programs, further training and subspecialisation is obtained via a craniofacial fellowship.
- Hand Surgery :Hand surgery is concerned with acute injuries and chronic diseases of the hand and wrist, correction of congenital malformations of the upper extremities, and peripheral nerve problems (such as brachial plexus injuries or carpal tunnel syndrome). Hand surgery is an important part of training in plastic surgery, as well as microsurgery, which is necessary to replant an amputated extremity. The Hand surgery field is also practiced by orthopedic surgeons and general surgeons (see Hand surgeon). Scar tissue formation after surgery can be problematic on the delicate hand, causing loss of dexterity and digit function if severe enough.
- Microsurgery :Microsurgery is generally concerned with the reconstruction of missing tissues by transferring a piece of tissue to the reconstruction site and reconnecting blood vessels. Popular subspecialty areas are breast reconstruction, head and neck reconstruction, hand surgery/replantation, and brachial plexus surgery.
- Pediatric Plastic Surgery :Children often face medical issues very different from the experiences of an adult patient. Many birth defects or syndromes present at birth are best treated in childhood, andpediatric plastic surgeons specialize in treating these conditions in children. Conditions commonly treated by pediatric plastic surgeons include craniofacial anomalies, cleft lip and palate and congenital hand deformities.