Hand Surgery Procedures Offered

Hand surgery is a speciality that is performed by either orthopaedic surgeons (bone doctors) or plastic surgeons. The beauty of hand surgery is that it is a combination of bone work (like fractures of bones) and reconstruction of soft tissues (skin, tendons, nerve and muscle and blood vessels). These are usually very intimately related and most hand surgeons have done extra training in order to equip them to manage these intricate surgical procedures.

Dr van der Spuy’s practice is geared to manage a wide range of problems, including managing fractures of the upper limb, general lumps or pinched nerves, micro-surgical repair of damaged nerves or blood vessels and soft tissue reconstruction. His practice would manage traumatic injuries like fractures, lacerations or joint dislocations, chronic conditions like arthritis (osteoarthritis or rheumatoid arthritis), gout, as well as the management of the less common congenital hand anomalies.

Dr van der Spuy also offers a super specialised service catering for the needs of sportsmen and musicians.

Physiotherapists and occupational therapists play an important role in the management and rehabilitation of many of these problems. Dr van der Spuy therefore works closely with them.

Important pre-operative information

Blood thinning medications

The risk of bleeding in hand surgery procedures is fairly low. We tend to stop certain blood thinning medications like Disprin (aspirin), Plavix (clopidrogrel) or Warfarin before elective procedures. We weigh the benefit up against the risks of stopping certain medications. Some Warfarin patients might need to be pre-admitted to change to a blood-thinning drug (Heparin) that can be adjusted more readily. Disprin is an anti-platelet drug and should be stopped a week before the procedure. Please discuss this in your consultation with Dr van der Spuy to formulate a plan.

Fasting rules

The most important thing to note before an operation is to be fasted for six hours by the time you have the operation. This is to ensure that there is no stomach content that can be aspirated in the lungs at the time of the operation. You will be advised to be fasted (fluids and solids) from the night before if your operation is performed in the morning. Afternoon cases can usually have an early breakfast or coffee/rusks depending on the time of the scheduled case. Please enquire if you are uncertain.

Chronic Medications

Please continue your normal chronic medications (like anti-hypertensives) the day of the operation. You can take it with a small sip of water.

Other considerations

There are a few preparations that you have to consider before the surgery. Any shaving of hair required will be done in theatre. Please remove all nail polish and make sure that nails are clean and cut. If you are living alone consider the fact that it will be a challenge to fulfil your normal daily activities from preparing food to basic hygienic activities. Make sure you prepare for this.

Driving might be difficult in most cases post-operatively especially if the limb is immobilised in a cast. You might have to speak to your insurer. Please make arrangements for someone to pick you up from the hospital after the procedure.

Finally, most patients get booked off from work for a period of recovery. This period will be discussed between you and Dr van der Spuy and will depend on the type of work that you do and the kind of operation that was done. Please advise the practice if you require specific letters for your employer before the operation.

Finally, make sure that you have a nice book to read after the operation. You don’t always get a pass for leisure time like this!

Post Surgery Information

Here are a couple of guidelines that will help you through the post-operative recovery period. Please read these and ask personnel if you are uncertain on any of the following. Please visit our website www.capehandsurgery.co.za for more detail on your procedure or for any other information. Please feel free to leave a comment or tell us about your experience on the patient blog. This might be useful for other patients going through the same process. For further enquiries, please email the practice at info@capehandsurgery.co.za

Post Surgery Guidelines:

  1. You might have a local or nerve block (local anaesthetic) that takes away all the sensation and pain of the operated area. Please note that this block is worked out after 8-12 hours. Even if no pain is experienced, it is worth taking two ant-inflammatories (like Mybulen/Myprodol) before going to bed or when sensation is returning.
  2. After certain trauma (non-scheduled) cases oral antibiotics will be prescribed. Please comply with the prescription regulations. It is usually advisable to complete a course of five days.
  3. Please continue your blood thinning and/or any other chronic medication when you are discharged.
  4. It is advised to keep the operated hand/arm elevated for the first night after the operation. In the hospital it will be elevated in a sling. At home you can simply elevate it on a pillowslip and ensure it is elevated above the level of your heart.
  5. Your most important duty is to keep the wound dry until you see me again. This will prevent post-operative infection. You will be provided with a long glove that can help when showering. Please consult the practice if your wound gets wet. We will rather view it sooner than later.
  6. Smoking is bad for any wound healing, bone union, tendon and nerve healing and is probably the most common cause for post-operative wound sepsis.
  7. Make sure you have a follow-up date. It is usually just short of two weeks at which stage your wound will be examined in sterile conditions.
  8. Pain is normal and expected. We try and take away the sting of surgical pain with anti-inflammatories and light opioids (Tramacet / Tramadol). Pain that should alert you to phone me is crescendo or worsening pain, especially if you have a limb cast, that is paired with severe swelling. All patients experience of pain is different and my advice is not to suffer in silence or to be too brave. Rather take the analgesia prescribed, especially for the first 48 hours. This will ensure that the healing process is a happy and successful one.
  9. Movement is life: It is generally encouraged to start moving the fingers and thumbs or wrist as soon as possible after the operation, unless it is purposefully splinted for protection. I will advise you accordingly. This is very important in nerve surgery like carpal tunnel syndrome.
  10. With any nerve related procedures it needs to be mentioned that an array of different sensations or symptoms might be experienced after the nerve has been freed or released. This is normal and should be anticipated. In long standing cases relief takes months and return to optimal function can take up to 18 months. The nerve tends to be almost hypersensitive when it has been released and “new” or “atypical” sensations might be experienced for a few days whilst recovery takes place.
  11. Finally, we would welcome feedback of your experience, and comments can be left my website at www.capehandsurgery.co.za. The positive experience of fellow patients encourages other patients far more than anything I can say or do.