Consent
Consent is more than simply signing a form on the day of surgery. It is important that you have understood why you are having surgery and that you have tried all non-operative treatments before embarking on surgery. It is important that you have read the patient information provided about your condition and that you have had a chance to discuss with your specialist.
As the patient, you should be clear on the following aspects:
-Your diagnosis and prognosis
-Options for treatment including non-operative treatments
-The purpose and expected benefit of treatment
-The likelihood of success
-The risks inherent to surgery, however small the possibility of their occurrence, side effects and complications. You should also understand the consequences of non-operative treatments.
-Postoperative care and rehabilitation
General risks of hand surgery include infection, bleeding, tender or ugly scars, stiffness, swelling, nerve/vessel/tendon injury, recurrence and failure. These risks are small but you should discuss them with your surgeon.
You should also discuss the type of anaesthetic you are likely to have and particularly as much of hand surgery is performed in an awake patient. There are options of local anaesthetic, regional and general anaesthesia and you should bediscuss these with your anaesthetist. See section on ‘wide awake surgery’
Complications
The vast majority of the time surgery is uneventful and the post-operative course is smooth with ultimately a good outcome. It is essential that you have a good understanding of your condition and all treatment options including the outcome of no treatment (natural history).
INFECTION
Fortunately this is not a common problem around the hand due to its excellent blood supply and soft tissue coverage. If you notice increasing pain, swelling, redness around a wound you should contact me . Day 5-7 post-op are usually when infections can occur
Superficial infections are usually treated and resolve with antibiotics. Deep infections (rare) may require surgical washout. If in doubt please get in touch.
PAIN , STIFFNESS , SWELLING
High limb elevation, analgesia plus movement is usually encourage after surgery . One would expect day by day improvement after surgery. If this is not the case get in touch for review.
SCARS
Occasionally these can be tender or ugly but they should usually settle down as time passes. Fortunately scarring around the hand generally heal well. Desensitisation of scars may be required. Gentle massage with E45 cream maybe beneficial.
BLEEDING
This is not usually a problem . If there is any unexpected bleeding do get in touch for review – it is usually addressed with a change of dressings.
DAMAGE TO LOCAL STRUCTURES
Fortunately injury to nerves, vessels or tendons is rare. Occasionally there is numbness relating to post-operative swelling but one would expect this to settle down. It can become a real possibility in complex or revision cases.
FAILURE TO IMPROVE
Obviously the aim to make you better- this will be the case the vast majority of the time . However , sometimes perhaps due to the complexity of the problem it is possible that you do not improve.
.
COMPLEX REGIONAL PAIN SYNDROME
This is a condition characterized by excessive pain , swelling , stiffness and abnormal hair growth in response to an injury including surgery. The skin may appear shiny. Miss Umarji is pleased to say that her CRPS rate is very low (<1%) . Prompt high elevation , mobilization and using the hand can avoid CRPS. Hand therapists are especially helpful in avoiding and treating this.
NON-UNION OR MAL-UNION
This is when the bone (usually a scaphoid) fails to heal . This is usually related to poor blood supply. A wrist fracture may heal in the wrong position – this is more likely to be a complication of a fracture treated in plaster when perhaps an operation might have been the treatment of choice .
Smoking is implicated in poor bone healing.
Other complications
Numbness, neuroma formation, weakness, cold intolerance, anaesthetic complication.
