Condition caused by pressure from the median nerve in the wrist or carpal tunnel. You may feel pain, tingling sensations, numbness in your fingers, or weakness. Carpal tunnel syndrome is associated with several conditions, including: repetitive motions, fluid retention during pregnancy, nerve damage in the carpal tunnel, or rheumatoid arthritis.

Disabling disease that can cause severe inflammation in any joint in the body. In the hand, it can deform the fingers and impair movement.

Disabling disease of the hand in which thick bands of scar tissue form on the palm of the hand and can extend to the fingers, causing restricted movement and abnormal position of the fingers.

Hand surgery is an individualized procedure and can be performed on people of any age. It will be a good option for you if:
• You do not have medical conditions that could impair healing;
• You don't smoke;
• You have a positive attitude and realistic expectations of the surgical result;
• You are determined to follow the plastic surgeon's instructions;
• In some cases, hand surgery is necessary to treat wounds.

The success and safety of the surgical procedure largely depends on your sincerity during the consultation. You will be asked about your health, desires and lifestyle.

• The reason why you want to have the surgery, your expectations and the desired result;
• The options available in hand surgery;
• Medical conditions, drug allergies and medical treatment;
• Current use of medication, vitamins, natural medicines, tobacco, alcohol and drugs;
• Previous surgeries.

• Assess your general health status and any pre-existing health conditions or risk factors;
• Examine your hand in detail;
• Take photographs for medical records;
• Discuss options and recommend the most appropriate option to restore hand function;
• Discuss possible outcomes of the surgery and any potential risks or complications.

The decision to undergo surgery is a personal one and it is up to you to decide whether the benefits will achieve your goals and whether the risks and potential complications are acceptable.

You will be asked to sign the consent form to ensure that you fully understand the procedure you will undergo and any potential risks or complications.

• Bleeding (bruise); 
• Infection;
• Anesthetic risks;
• Unfavorable scars;
• Change in skin sensation;
• Irregularities in the skin contour;
• Skin discoloration/swelling;
• Poor healing of incisions;
• Hand edema;
• Allergies to tape, suture materials, glue, blood products;
• Deep vein thrombosis, cardiac and pulmonary complications;
• Damage to deeper structures such as nerves, blood vessels, muscles and lungs, which may occur and be temporary or permanent;
• Pain, which may last;
• Possibility of revision surgery.

From the carpal tunnel
• Little clinical improvement;
• Recurrence of carpal tunnel syndrome.

Extensor tendon
• Additional incisions may be necessary, as cut tendons may retract;
• Failure of tendon repair;
• Inability to restore function;
• Scar tissue over the tendon, limiting its movement.

Flexor tendon
• Additional incisions may be necessary, as cut tendons may retract;
• Inability to restore function;
• Scar tissue over the tendon, limiting its movement.

Tenolysis
• Abnormal tendon position;
• Additional incisions may be necessary over the previous scar or new incisions may be necessary to release the scar tissue that is limiting the movement of the tendon;
• Inability to restore function;
• Recurrence of scar tissue in the tendon;
• Tendon rupture;
• Seroma (accumulation of fluid).

Trigger Finger
• Little clinical improvement;
• Scar tissue over the tendon, limiting its movement.

Preparing for surgery
Before surgery, it may be necessary to:
• Take laboratory tests or medical evaluation;
• Taking certain medications or adjusting current medications;
• Stop smoking well in advance of surgery;
• Avoid taking aspirin, anti-inflammatories and natural medicines, as they can increase bleeding.

• What to do on the day of surgery (fasting time, medications, bath);
• Information on the type of anesthesia to be performed during the surgical procedure;
• Guidance on post-operative care.

The procedure must be carried out in a safe and comfortable place for the doctor and the patient, in a surgical center authorized by the Health Surveillance, with equipment and trained staff for any complications.

Be sure to ask someone to accompany you and stay with you for at least the first night after surgery.

Step 1 – Anesthesia
Medications are administered for your comfort during hand surgery. Options include intravenous sedation and general anesthesia. Your doctor will recommend the best option for you.

Step 2 – The Incision
Trauma Treatment
The most common injury to a traumatized hand or finger that requires surgery is tendon repair. When a tendon is cut, it will be explored from the original wound site. Tendon repair repairs the collapsed tendon and reconnects it using surgical techniques to restore function and movement.

Carpal Tunnel Syndrome
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 carpal tunnel that presses on the nerve. An alternative procedure is endoscopic carpus release, with smaller incisions and use of a surgical microscope or endoscope (a small flexible tube that contains a light and camera), to release the carpus.

Congenital Deformities
When the fingers fuse at birth, called syndactyly, they can be joined only by skin or by partial fusion of bones. The surgery involves separating the two fingers to provide a full range of motion and normal appearance, as well as to allow normal growth of the finger. Techniques such as skin grafts or a local flap procedure, such as Z-plasty, create flexibility at the incision site for finger growth and movement.
The plastic surgeon can recommend a technique or a combination of techniques to achieve your goals. Some of these techniques include: microsurgery, skin, bone, nerve or other tissue grafts from healthy parts of the body, Z-plasty and physiotherapy.

Step 3 – Closing the Incisions
Depending on your condition and the type of treatment, the incisions will need to be closed with removable sutures or non-removable sutures.

Step 4 – Results
The results of hand surgery will appear gradually as the swelling decreases and good work with a specific physiotherapist is carried out. The final result may appear after several months.

After surgery, occlusive bandages and micropores can be applied to keep the surgical site clean and splints can be used if necessary.

How to care for your hand(s), medications to take orally to reduce the risk of infection, and when to return for follow-up with the plastic surgeon.

• Where will I remain in recovery after surgery is complete?
• What medication will I be given or prescribed after surgery?
• Will there be dressings after surgery? When will they be removed?
• Will the stitches be removed? When?
• When will I be able to resume normal activities and exercise?
• When will the return appointment be?

Follow all post-operative instructions, including cleaning, prescribed medications, and hand physical therapy exercises. Physiotherapy is essential for restoring flexibility, strength and movement. If you return to normal function too quickly, the risk of re-injury is possible. Continue your physical therapy treatment and return periodically for follow-up appointments with your plastic surgeon.

The final result of the surgery will appear over time. Even with advances related to hand surgery, the outcome cannot be fully predicted. If you have had surgery to correct carpal tunnel syndrome, modifying work habits is vital for long-term improvement. If the procedure involved microsurgery, one year is considered adequate to achieve complete restoration of function.

Cost is always a consideration in elective surgery. A surgeon's fees can vary based on their experience and the type of procedure performed.

The cost may include:
• Surgeon's fees;
• Hospital or surgical center costs;
• Anesthetist's fees;
• Prescribed medications;
• Medical exams.

When choosing a plastic surgeon, remember that the surgeon's experience and your good relationship with him or her are as important as the final cost of the surgery.

• Carpal tunnel syndrome: Condition caused by pressure on the median nerve in the wrist or in the carpal tunnel, causing tingling, pain and numbness.
• Dupuytren's contracture: Disabling hand disorder in which thick bands of scar tissue form in the palm of the hand and can extend into the fingers, which can cause restricted movement and abnormal position of the fingers.
• Extensor tendon: Tendon that serves to extend a part of the body.
• Flexor tendon: Tendon that serves to bend a part of the body.
• General anesthesia: Drugs and/or gases used during surgery to relieve pain and reduce consciousness.
• Graft: Tissue taken from other parts of the body.
• Intravenous sedation: Sedatives given by injection into a vein to help you relax.
• Microsurgery: Augmentation to repair or reconnect nerves and tendons, (common in cases of trauma) often used in reimplantation of severed fingers or limbs.
• Polydactyly: Presence of extra fingers.
• Rheumatoid arthritis: Disabling disease that can cause severe inflammation in any joint in the body, which can deform the fingers and impair movement.
• Syndactyly: When the fingers are fused.
• Tenolysis: Surgical procedure to free a tendon from surrounding adhesions.
• Trigger finger: Abnormal condition in which the flexion or extension of a finger may be momentarily obstructed by spasm followed by a clicking sound in its place.
• Zetaplasty: A surgical incision technique that creates small triangular flaps of tissue that help close wounds over areas of the hand where bending or flexion is essential to function, such as around fingers.

Use this list as a guide during your consultation:
• Are you a specialist by the Brazilian Society of Plastic Surgery?
• Have you been trained specifically in the field of plastic surgery?
• How many years of plastic surgery training have you had?
• Is the installation of the surgical center in your office authorized by the Health Surveillance of your city?
• Am I a good candidate for this procedure?
• What is expected of me so that the best results are obtained?
• Where and how will the procedure be performed?
• Which surgical technique is recommended for my case?
• How long can I expect to recover, and what kind of help will I need during my recovery?
• What are the risks and complications associated with my procedure?
• How are complications treated?
• What are my options if I am unhappy with the result?