Elevation of the hand above the level of the heart.

Post operative care following hand surgery

Surgery causes your body to produce inflammation and swelling which can be painful and make it difficult to move your joints. It can also cause complications in the later stages of healing.

It is essential therefore that you elevate your hand to help drain the swelling after surgery. You may be given a sling to take home, which should be used for the first 48 -72 hrs.

Your hand needs to be elevated right above your head for a few minutes in every hour and any joints not immobilized by the dressing or plaster must be exercised (including fingers, wrist, elbow and shoulder if appropriate).You should also keep your hand raised ,when resting, above the level of your heart.

Elevation uses gravity to assist drainage of the swelling. Movement of the unaffected joints helps with the body’s “pumping mechanism” as well as preventing unnecessary joint stiffness.

Every hour you should:-
Raise your hand above your head.
Take all unaffected joints through their full range of movement.

It is normal for your hand to swell and bruise after your operation. If you find that your hand is painful, you should take your normal pain killers, but if the pain persists, you should seek advice from your G.P or the hospital where the surgery was undertaken.

Follow Up care

The suture used to close your wound is normally dissolvable and so will not need removing.
Your wound should remain covered, clean and dry for the first 10 days to 2 weeks.

After this time you should allow the wound to get some air to help it dry out and heal.

If your fingers are free from dressings you should try to use your hand as normally as you can for light activities at first: gradually increasing the weight you lift from about 4-6 weeks. If you should not use your hand, it will be immobilized with a plaster cast or splint and you should take advice about it from your therapist.

Once the wound is healed and dry (usually at around 2 weeks) you should moisturize the scar with non-scented cream e.g E45 or aqueous cream, in a circular and FIRM motion. This will help sooth the tenderness in the scar, reduce the formation of scar tissue and help with hand movement and function. This is an essential part of your aftercare following surgery.

Sometimes people suffer with sore scars or stiff fingers post-operatively. If you are at all concerned with your scar, the pain or how your hand is moving please contact the G.P, therapist, or treating hospital for advice.

There is always a lot to think about when coming in for surgery. Below is a summary of the usual steps taken during your surgical stay.

Pre-assessment
All patients undergoing surgery, however minor, will need some form of assessment prior to the day of surgery.
This can take place over the phone or require a visit to the treating hospital.
A medical history will be taken, including information on current medication being used. On occasions tests will be carried out including blood and heart tests and chest X-rays.
You will be advised if you need to stop certain medications before the day of surgery including aspirin and warfarin.

Arrival at hospital
You will be advised on what time to arrive at your treating hospital. You will also be advised on when you can last eat and drink before surgery. As a rule you should not have food for at least 6 hours and no clear fluids for at least 2 hours before general or peripheral anaesthesia. If simple local anaesthetic is being used then I am happy for most people to eat and drink up to the time of surgery (within moderation).
If you are diabetic, or have other specific risk factors, then this protocol may change. This will be discussed with you.

Anaesthetic
Pain relief during and after surgery is paramount. There are numerous ways in which to achieve anaesthesia to a surgical site. In simple terms it can be divided into:-
a). Local anaesthetic = anaesthetic is injected into the area where the surgery will take place. This causes only the operative area to become numb, with the rest of the limb remaining normal. e.g carpal tunnel surgery.

b). Peripheral anaesthetic = anaesthesia is injected at the top of a limb (e.g around the armpit), away from the area where the surgery will take place. This causes the whole limb (including the operative area) to go numb. This can be used in most upper limb operations.

c). General anaesthesia = anaesthesia is induced centrally, so that you are in a state of unconsciousness and so the whole body is affected

Often a combination of anaesthesia is undertaken. For example a general anaesthetic is used first to put you off to sleep, and then a peripheral anaesthetic is added, so that good pain relief is present when you wake up.

Anaesthesia is extremely safe these days, and serious complications are very rare.
I work with a group of very experienced anaesthetists who will discuss with you before surgery on what the best anaesthetic is for your needs.

Post Surgery pain relief
As stated above, pain relief is of paramount importance to me for all my patients. You will be prescribed pain relief post surgery by the Anaesthetist. Surgery can be a painful experience, but with modern techniques and good medication, this should be a rare occurrence after surgery.

Home discharge after surgery
I see all patients after I have performed surgery on them. This is to let them know how the surgery went, and my post-operative plan for you. I will hopefully be able to answer any questions that you have.
You go home when the treating team (surgeon, anaesthetist, nurses, the patient, and if applicable the physiotherapist) are happy that you are ready for discharge.
You need to fulfill a number of criteria to be discharged including:-

• Adequate pain relief
• Safe to mobilise
• Wound and dressings assessed
• Aware of post operative instructions
• Someone to help at home if required
• Safe environment to be discharged to

If you have any questions before your date of surgery, please do not hesitate to contact my relevant secretary, and your question(s) should be answered.