Hand surgery

The hand surgery deals with the treatment of diseases and injuries of the forearm and hand. In Germany, this is done by specially trained surgeons.

history

Hand surgery evolved from orthopedics and surgery . Like many surgical disciplines, hand surgery was stimulated by war injuries. As an independent specialist area that developed in the second half of the 20th century, it is interwoven with plastic surgery . The pacemakers in hand surgery are Sterling Bunnel (USA), Erik Moberg (Sweden), Marc Iselin , Hanno Millesi and Dieter Buck-Gramcko (Germany). and Ulrich Lanz (the son of the anatomist Titus von Lanz ), who, after completing his training in the USA under Ernst Kern, established hand surgery in Würzburg. After Ulrich Lanz (* 1940 in Munich) performed the first finger transplant in Würzburg's Bavaria in 1975, there had been around 750 such operations in 1991.

tasks

Hammer finger

Hand surgery deals with the diagnosis and treatment of acute or chronic damage or injuries to the upper extremities (shoulder, upper arm, forearm, hand, fingers, thumb). The field of hand surgery includes the prevention, detection, operative and conservative treatment of diseases, injuries, malformations and tumors of the hand and forearm, as well as reconstruction after diseases or injuries.

Specific tasks

The main specific tasks of hand surgery include the treatment of:

• Injuries to finger bones, tendons , ligaments, wrist (e.g. scaphoid fracture ), forearm bones (e.g. distal radius fracture ), ulnar-spoke joint ( distal radioulnar joint ) as well as blood vessels and nerves ( brachial plexus ) including amputations of fingers, the hand or the arm.
• Burns to the upper extremity
• Chronic diseases of the joints ( osteoarthritis , arthritis , rheumatoid arthritis ), circulatory disorders of the soft tissues and bone (eg. As lunatomalacia ), narrowing of nerve or tendon sheaths (z. B. carpal tunnel syndrome , ulnar tunnel syndrome , sulcus ulnar nerve syndrome ), tendovaginitis stenosans , of the connective tissue ( Dupuytren's contracture )
• Infections of the soft tissue ( panaritium , flexor tendon sheath infection ) and bone (osteitis)
• Tumors (benign or malignant growths) and cyst formations (ganglia) of the hand and arm
• congenital (child) malformations (polydactyly, thumb aplasia)
• complex regional pain syndromes (CRPS)
• Functional restrictions / losses of the upper extremity as a result of illnesses (e.g. spastic paresis , paralysis) or injuries (e.g. after nerve injuries) with restoration of function (motor replacement operations)

This includes the treatment of children (child malformations ), rheumatics and chronic pain syndromes ( complex regional pain syndrome ), the replantation of fingers up to entire extremities as well as the care of patients with prostheses and the rehabilitation of hand injured patients who have special training requirements Therapist poses.

The complex and consistent follow-up treatment with occupational therapy is of the utmost importance for the success of the therapy . Physiotherapy and physical therapy are complementary measures.

Technical requirements and resources

Removal of a finger lipoma

• atraumatic surgical technique
• special instruments
• special sutures
• Magnifying glasses or better telescopic glasses
• Surgical microscope
• Tourniquet: in order to enable an anemic surgical field, the blood flow to the upper arm is interrupted with a pneumatic cuff
• Blood depletion: in order to allow a blood-free operating area, the arm is wrapped around the periphery with an elastic bandage before the tourniquet
• further prerequisites for interventions on the hand were the introduction of asepsis and modern anesthesia in the second half of the 19th century.

Additional training in hand surgery in Germany

The designation "hand surgery" can be acquired through a 36-month advanced training course . The aim of the additional training is to acquire specialist skills in hand surgery after completing the prescribed training time and training content, which are defined by the locally responsible medical associations. The prerequisite for continuing education in hand surgery is recognition as a specialist z. B. Specialist in orthopedics and trauma surgery , surgery , orthopedics or plastic surgery . The competent medical associations are authorized to undertake further training.

Organization in associations

In Germany, hand surgery is organized in the German Society for Hand Surgery (DGH) and in sections and working groups of specialist societies. The German Society for Hand Surgery (DGH) is the association of surgeons, plastic surgeons, trauma surgeons and orthopedic surgeons who mainly work in hand surgery in the Federal Republic of Germany. The DGH represents the medical and scientific interests of hand surgery vis-à-vis other medical specialist societies, medical professional associations, health care institutions, cost and hospital sponsors. The DGH was founded in 1990. It is a member of other non-profit or public corporations such as the Federation of European Hand Surgery Societies (FESSH) and the International Federation of Hand Surgery Societies (IFSSH). Hand surgery clinics can be certified as "Hand Trauma Centers" (HTC) by FESSH. The prerequisite for this is, among other things, a 24-hour readiness to treat even complex hand injuries including the replantation of severed fingers / hands. In the German Society for Trauma Surgery (DGU), the interests and concerns of hand surgery are represented by the permanent hand surgery section. The German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC) presents hand surgery in a separate section. In the German Society for Orthopedics and Orthopedic Surgery (DGOOC) it is the Hand, Microsurgery and Replantation Surgery section. The cooperating sections deal with improving the care of injuries and diseases of the hand and their subsequent conditions.

literature

• M. Sauerbier, A. Eisenschenk, H. Krimmer, B.-D. Partecke, H.-E. Schaller (Ed.): The hand surgery . Elsevier Verlag, 2014, ISBN 978-3-437-23635-8 .
• H. Towfigh, R. Hierner, M. Langer, R. Friedel, (Eds.): Handchirurgie . Springer Verlag, 2011, ISBN 978-3-642-11758-9 .
• S. Pechlaner, H. Hussl: Operation Atlas Hand Surgery . Thieme Verlag, 1997, ISBN 3-13-101171-8 .
• J. Rudigier, R. Meier: Brief Hand Surgery: Clinic and Practice . 6th edition. Thieme Verlag, 2014, ISBN 978-3-13-126426-8 .
• D. Buck-Gramcko: A life for hand surgery: 100 life pictures. Verlag Steinkopff, 2007, ISBN 978-3-7985-1776-9 .
• The Journal of Hand Surgery - European Volume
• Ulrich Lanz: History of hand surgery. In: Therapeutic review. Volume 52, 1995, pp. 9-11.
• Gabriele Walura, Jan Cruse, Margret Liehn, Rainer Thönnessen: Hand surgery , in: Margret Liehn, Brigitte Lengersdorf, Lutz Steinmüller and Rüdiger Döhler : OP manual. Basics, instruments, operating procedures , 6th, updated and expanded edition. Springer, Berlin Heidelberg New York 2016, ISBN 978-3-662-49280-2 , pp. 252-273.
• The Journal of Hand Surgery - American Volume

Web links

Wiktionary: Hand surgery  - explanations of meanings, word origins, synonyms, translations

• German Society for Hand Surgery
• Federation of European Societies for Surgery of the Hand
• International Federation of Societies for Surgery of the Hand
• Further Education Regulations Baden-Württemberg, special edition ÄBW 4/2006, status 2/2007, p. 93. (PDF file; 446 kB)

Individual evidence

1. ↑ Dieter Buck-Gramcko †: A life for hand surgery. In: Deutsches Ärzteblatt. 2012; 109 (45). Retrieved May 9, 2016.
2. ↑ Rolf habenicht: A life for hand surgery. .
3. ^ Dieter Buck-Gramcko: Ulrich Lanz for his 70th birthday. In: hand surgery, microsurgery, plastic surgery. Volume 43, No. 3, 2011, p. 194. doi: 10.1055 / s-0031-1275305 .
4. ↑ Ernst Kern: Seeing - Thinking - Acting of a surgeon in the 20th century. ecomed, Landsberg am Lech 2000, ISBN 3-609-20149-5 , p. 247.
5. ↑ Ernst Kern : Seeing - Thinking - Acting of a surgeon in the 20th century. ecomed, Landsberg am Lech 2000, ISBN 3-609-20149-5 , pp. 34 and 179.
6. ↑ ^{a b} Further training regulations for the North Rhine Medical Association of October 1, 2005 in the version of August 28, 2014 (PDF). aekno.de. Retrieved May 9, 2016.
7. ^ E. Chronopoulos et al .: Patient presenting with lipoma of the index finger: a case report. In: Cases Journal. 3, 2010, p. 20. doi: 10.1186 / 1757-1626-3-20 PMID 20205806 ( Open Access )
8. ↑ Christoph Weißer: Hand surgery. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 530 f.
9. ↑ ^{a b} Articles of Association of the German Society for Hand Surgery (DGH). dg-h.de. Retrieved May 9, 2016.

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