Surgical reconstruction of the rheumatoid hand

PATHOPHYSIOLOGY: The pathophysiology involved in rheumatoid arthritis of the hand will be discussed, focusing on the anatomical derangements of the joints that result from the disease process. The consequences of these deformities on overall had function will be addressed. SURGERY: The pioneering work in implant arthroplasty of the rheumatoid hand was done by Alfred B. Swanston, M.D., of Grand Rapids, Michigan in the 1960s. The paper will focus on the indications for surgery as well as the currently accepted surgical techniques utilized in surgical reconstruction of the rheumatoid hand and wrist. REHABILITATION: After reconstruction hand surgery, a properly supervised rehabilitation programme is essential to guarantee a satisfactory outcome in the restoration of hand function. ECONOMICS OF RECONSTRUCTIVE HAND SURGERY: In the current era of cost effective health care delivery, this type of surgery does not have to be performed in a major hospital setting. With effective regional anaesthesia and proper instrumentation, the surgery can be successfully performed in a free standing speciality clinic(AU)

The role of microsurgery in the management of hand injuries - abstract

The operating microscope was first used in clinical surgery in 1922 and, since then, major advances have been made in the field of microsurgery worldwide. The use of magnification has had a major impact on the development of hand surgery as a subspecialty. With the advent of modern microsurgery, many devastating hand injuries can now be successfully treated and, in many instances, satisfactory hand function restored. For example: (1) amputated digits and hands can be successfully replanted in some situations; and (2) post-traumatic reconstructive surgery of the hand can be performed, using microvascular techniques (e.g., toe-to-hand transfer for thumb reconstruction). It is feasible to develop microsurgery in the Caribbean. The basic method involved in training is quite simple. A microsurgical laboratory could be established at the Mona Campus of the University of the West Indies. Former medical students of the UWI would assist with the development and cost of maintenance of the technology. A successful microsurgery programme would be feasible (AU)