Dr. Gustavo Arnoldo López Paz
Hand Surgery – Microsurgery, Orthopedic Surgery and Orthopedics
MULTIMEDICA VISTA HERMOSA
Why look for a surgeon specialized in the hand and upper limb?
Since the II World War, Professor Sterlin Bunnel brought together a team of specialists, including traumatologists, orthopedists, neurosurgeons, vascular surgeons, and rehabilitation physicians, to create the first service of hand and upper limb surgery, founded in San Francisco CA, in the naval hospital of the city. This was the origin of what is now the specialty of hand and upper limb surgery.
These specialists train after a previous specialty, like for example a traumatologist and orthopedic surgeon that after 4 or 5 years of previous specialization, has the opportunity to attend an international center recognized as a center of education and training to do a 2nd specialization denominated hand surgery and reconstructive microsurgery. Here the specialist dedicates additional time to specialize in this branch that is so specific. This branch has grown in the last 25 years because of the microsurgery technique. Microsurgery is the technique where the microscope is brought into the operating room to perform vascular procedures and repair miniature nerves like the one in the fingers. These training centers have dedicated their practice specifically to these types of injuries, to train these doctors that have gone out and spread the specialty throughout the entire world.
Currently there are multiple societies in the United States, there are two in Canada, multiple in Europe, and in Guatemala there is the Guatemalan Hand Surgery Association that brings all those specialists together. All the members of the Guatemalan Hand Surgery Association have had additional training in this specialty.
Which cases are managed by a hand surgeon?
The hand surgeon that has had previous training in plastic surgery or general surgery, or in traumatology or orthopedics, is professionally able to manage almost any injury in the upper limb. For example if there is a patient that has a hand amputation, the hand surgeon and his team, are able to do a reimplantation.
In the past when there was a case as particular as this one, in which there was a hand amputation, the traumatologist, who would fix the bone, was initially called. Then the vascular surgeon was called to work on the arteries and veins. Then the plastic surgeon was called to work with the tendons. Afterwards, a neurosurgeon was called to treat the nerves of these injuries. Finally, the patient was sent to a therapy program were the therapist was not specifically trained to work on a limb so severely damaged.
The first Hand Therapist Association was founded in Guatemala 8 years ago by therapists who have dedicated additional time to learn the management protocols of such specific injuries of the hand. Going back to the topic of reimplantation, a patient that has an amputation needs a specialized person for his/her rehabilitation. This type of therapist knows the way around prosthetic appliances for finger movement, knows the care that a hand must have after undergoing vascular work and nerve repair, how far movement can go without injury, and knows about the management of hand temperature when nerves have been cut and patients do not feel and can burned very easily.
These hand therapists work together with the doctors so that the management is supervised and evaluated from both professional points of view. The hand surgeon is capable of treating children with birth defects, such as when they are born with webbed fingers, also known as syndactyly; or with extra fingers, with double thumbs or hands that have 6 or 7 fingers, and patients born with different atrophies, or elbow problems at the level of the hand and wrist. The opinion of a hand surgeon in the treatment of congenital abnormalities is extremely important, given that he/she has a point of view completely different from the rest of specialties because he/she seeks functional recuperation of the patients.
For many years it has been thought that surgery with tiny incisions like the ones performed in the abdomen, knee, or shoulders, which is called arthroscopy, is microsurgery. This is a mistake. Surgery with tiny orifices is not the same as microsurgery. Microsurgery means bringing in the microscope into the operating room and performing the surgeries through the magnifying capability of such device. The microscope is used for example when patients have severe injuries in the hands and have lost fingers.
The micro-surgeon is able to transfer toes to the hands and make the hand functional. This type of surgery is frequent in Guatemala. They are performed by experts that have had many years of specialized practice and success in these types of surgeries. The microscope is also used in patients that have nerve injuries in the neck to properly repair the nerves under magnification. These nerves are treated in a very special way because they are very soft, as if we were suturing a very soft paste. The threads used are thinner than human hair and a special instrument is needed to handle the microscopic needle and pass it from one side of the injury to the other and suture it properly. When the surgeon masters this technique, he can remove a back muscle with its arteries, veins and nerves, and place it for example in a leg that has undergone a big loss of skin. In a single surgery the muscle is transferred from the back and reconnected properly to cover the defect that the accident caused.
In conclusion, the hand surgeon is a specialist dedicated to the care and treatment of the hand and upper limb. Currently in Guatemala, different high quality hospitals offer specialized hand surgery in their emergency service to cover these types of injuries. Guatemala is one of the most advanced countries in Central America in this specialty given that no other country in Central America has a hand surgeon association nor a hand therapy and rehabilitation association.
If you have a hand or the upper limb injury, look for the appropriate specialist.