Hand surgery
Hand surgery is a medical specialty that deals with the diagnosis, treatment and rehabilitation of injuries, diseases and deformities of the hand and wrist. It includes both conservative and surgical measures.
The hand is a complex and highly specialized organ consisting of numerous bones, joints, tendons, muscles, nerves and blood vessels. Hand surgery treats a variety of conditions and injuries, including fractures (broken bones), tendon injuries, nerve injuries, arthritis (joint inflammation), ganglions (bursal cysts), Dupuytren's contracture (curvature of the fingers), carpal tunnel syndrome (nerve compression in the wrist), and many others.
Hand surgery treatment can be both conservative and surgical. Conservative measures include the use of splints or bandages to immobilize the hand, physical therapy exercises to strengthen muscles and improve mobility, and administration of anti-inflammatory medications or injections to relieve pain.
In cases where surgery is required, hand surgery may use various techniques. These include tendon reconstruction, fixation of bone fractures with screws or plates, removal of tumors or cysts, correction of deformities, and nerve reconstruction. Hand surgery requires special training and expertise because the hand is an extremely sensitive and functionally important organ.
Tendovaginitis stenosans (snapping finger)
Tendovaginitis stenosas, also known as "snapping finger", "snapping finger" or "jumping finger", is a disease in which a tendon in the hand or finger becomes inflamed and thickened. This can lead to difficulty moving the affected finger as it suddenly gets stuck when bent or extended and then released with a jerky jump of movement. The exact cause of this condition is not fully understood, but repetitive strain, injury, or certain medical conditions may increase the risk. Treatment options range from conservative measures such as rest, physical therapy, and anti-inflammatory medications to surgery to restore mobility to the finger. It is important to see a specialist for an accurate diagnosis and appropriate treatment options.
Surgical treatment of tendovaginitis stenosas can vary depending on the severity and individual circumstances. A common method is the so-called tendon exposure or annular ligament splitting. This involves making a small incision in the hand or finger to open the thickened tendon sheath and allow the tendon to pass through smoothly. In some cases, partial removal of the tendon sheath may also be necessary. This procedure is usually performed under local anesthesia and usually does not require an overnight stay in the hospital. Recovery time varies, but typically most patients can resume normal activities within a few weeks. It is important to follow the doctor's postoperative instructions and, if necessary, perform physical therapy to restore full mobility and function to the finger.
Quervain's tenodvaginitis
De Quervain's tendovaginitis, also known as De Quervain's tenosynovitis, is an inflammatory disease of the tendon sheaths in the area of two extensor tendons of the thumb (APL and EPB tendons). It occurs when the tendons that move the thumb become irritated and inflamed due to friction or overuse.
The cause of de Quervain tendovaginitis can be varied. It often occurs during repetitive movements in which the thumb is abducted (moved outward) and extended upward at the same time. This can occur, for example, in certain sports such as tennis or golf, but also in professional activities such as lifting heavy objects or working with tools.
Typical symptoms of de Quervain's tendovaginitis are pain and swelling in the wrist on the thumb side. The pain can spread to the forearm and is often exacerbated by gripping, turning or lifting objects. A grinding or rubbing sensation often occurs when moving the thumb.
Treatment of de Quervain's tendovaginitis can initially be conservative. These include measures such as rest, wearing a splint to immobilize the thumb, anti-inflammatory medications and physiotherapy exercises to strengthen the muscles and improve mobility. In some cases, a local cortisone injection into the inflamed tendon sheaths may be considered. If symptoms persist, surgical treatment may be necessary to open the irritated tendon sheaths and reduce pressure on the tendons.
Ganglion
A ganglion is a benign, fluid-filled cyst that forms near joints or tendons. It is one of the most common types of soft tissue tumors.
Ganglions can occur in various locations in the body, but are most commonly found on the wrists and fingers. They can also occur on the ankles, knees, or other joints.
The exact cause of ganglion formation is not known. However, it is believed that they can arise from a buildup of synovial fluid or from a protrusion of the joint capsule or tendon sheath.
Ganglia are usually painless unless they are pressing on nerves or other sensitive structures. However, they can be aesthetically disturbing or impair the mobility of the affected joint.
The diagnosis of a ganglion is usually made through physical examination and, if necessary, through imaging techniques such as ultrasound or magnetic resonance imaging (MRI).
Treatment for a ganglion can be conservative or surgical, depending on the size, location, and symptoms of the ganglion. Conservative treatment methods include rest, immobilization of the affected area, application of heat or cold, and aspiration (removing fluid from the ganglion with a needle). In some cases, surgery may be necessary to completely remove the ganglion.
It is important to see a doctor if you have or suspect you have a ganglion as only a specialist can make the correct diagnosis and recommend the appropriate treatment.
The operation to remove a ganglion is called a ganglionectomy. The exact procedure of the operation can vary depending on the location and size of the ganglion, but in general, ganglionectomy involves the following steps:
Preparation: The patient is usually placed under local or general anesthesia so as not to feel any pain during the procedure. The affected area is cleaned and covered sterile.
Access to the ganglion: An incision is made near the ganglion to gain access. The exact location of the incision depends on the location of the ganglion. In some cases, an arthroscopic procedure may be used, in which small instruments are inserted through tiny incisions.
Identification and removal of the ganglion: The ganglion is identified and carefully detached from the surrounding tissues. It may be necessary to completely remove the ganglion or partially remove it if it is connected to a tendon or joint.
Check for additional lesions: After removing the ganglion, the surgeon will check the area for any additional lesions or abnormalities.
Wound closure: The wound is carefully stitched or closed with medical adhesive to allow proper healing.
Dressing and aftercare: A sterile bandage is applied to protect the wound and support the healing process. The patient will receive instructions on how to care for the wound and follow-up care, including possible physical therapy exercises.
Most ganglionectomies are outpatient procedures, meaning the patient is discharged home the same day. Recovery time varies depending on the individual case, but typically most patients can resume normal activities within a few weeks.
Nerve congestion syndrome
Nerve entrapment syndrome, also known as nerve compression syndrome, occurs when a nerve becomes pinched or compressed at a specific point in its course. This can cause pain, numbness, tingling and muscle weakness.
There are different types of nerve entrapment syndromes, which can cause different symptoms depending on the nerve affected and the location of the compression. Some of the most common nerve constriction syndromes are:
→ Carpal tunnel syndrome
This is a compression of the median nerve in the wrist area. Typical symptoms include pain, numbness and tingling in the fingers, especially the thumb, index and middle fingers.
→ Cubital tunnel syndrome / ulnar sulcus syndrome (SUS)
The elbow nerve (ulnar nerve) is pinched at the elbow. This can cause pain, numbness, and tingling in the pinky and ring fingers.
→ Loge de Guyon Syndrome
Also known as Guyon Canal Syndrome, the ulnar nerve is pinched or compressed in the wrist area. The ulnar nerve passes through a narrow canal called Guyon's canal, which extends between the carpal bones and a tight band of connective tissue.
Treatment for nerve entrapment syndrome can be conservative or surgical, depending on the severity of the symptoms and the cause of the compression. Conservative measures include rest, physical therapy exercises to strengthen muscles and improve mobility, anti-inflammatory medications, and wearing splints or bandages to relieve pressure on the affected nerve. In some cases, surgical exposure or decompression of the nerve may be necessary to relieve symptoms.
Tendon reconstruction
Tendon reconstruction is a surgical procedure that repairs or replaces a damaged or torn tendon. Tendons are fibrous tissues that connect muscles to bones and enable movement.
There are various reasons why a tendon may need to be reconstructed. These include injuries such as tendon tears or ruptures, degenerative diseases such as tendonitis or tendinosis, and congenital anomalies or structural problems.
The exact procedure for tendon reconstruction depends on the affected tendon and the severity of the injury. However, in general, the procedure includes the following steps:
1. Access to the affected area: An incision is made to gain access to the affected tendon. The incision may vary depending on the location of the tendon and the individual circumstances of the patient.
2. Identification and preparation of the damaged tendon: The damaged or torn tendon is identified and prepared. This may include removing scar tissue or inflamed tissue.
3. Repair or replacement of the tendon: Depending on the condition of the tendon, it can either be repaired directly by putting the torn ends back together, or a replacement material can be used to restore the function of the tendon. Replacement materials can be the body's own tendons (autologous transplants) or synthetic materials.
4. Wound closure and dressing: After tendon reconstruction is complete, the wound is sutured and a bandage is applied to aid healing.
After surgery, rehabilitation and physical therapy are usually necessary to restore mobility, strength and function to the affected limb. The exact rehabilitation plan depends on the type of tendon reconstruction and the individual needs of the patient.
Tendon transfer/tendon repositioning
A tendon rearrangement, also known as tendon transposition or tendoplasty, is a surgical procedure in which a tendon is moved from its original position to a new position. This procedure is performed to restore function to a damaged or no longer functional tendon.
There are several reasons why tendon repositioning may be necessary. These include injuries, degenerative diseases, or structural abnormalities that affect the tendon's normal function. A tendon rearrangement may also be performed to relieve pressure on a nerve or to provide better stability or alignment of a joint.
The exact procedure for a tendon relocation depends on the affected tendon and the individual circumstances of the patient. However, in general, the procedure includes the following steps:
1. Access to the affected area: An incision is made to gain access to the affected tendon and surrounding tissue. The incision can vary depending on the location of the tendon and the individual needs of the patient.
2. Identification and preparation of affected structures: The damaged or non-functional tendon as well as other affected structures such as muscles or ligaments are identified and prepared. This may include removing scar tissue or inflamed tissue.
3. Rearrangement of the tendon: The affected tendon is released from its original position and relocated to a new position. This may mean passing the tendon through a new tunnel or attaching it to another muscle or bone to restore function.
4. Fixation of the tendon: The relocated tendon is fixed in its new location using special sutures, staples, screws or other fixation devices.
5. Wound closure and dressing: After the tendon relocation is complete, the wound is sutured and a bandage is applied to support healing.
After surgery, rehabilitation and physical therapy are usually necessary to restore mobility, strength and function to the affected limb. The exact rehabilitation plan depends on the type of tendon relocation and the individual needs of the patient.
It is important to follow the surgeon's instructions carefully after surgery and to consult your doctor if you have any questions or concerns.
Motor replacement plastic
Motor replacement surgery is a surgical procedure in which a damaged or no longer functional muscle group is replaced with another muscle group in order to restore motor function. This type of surgery is often used for severe injuries, paralysis, or congenital anomalies in which normal muscle function is impaired.
The exact procedure for motor replacement surgery depends on the muscle group affected and the patient's individual circumstances. However, in general, the procedure includes the following steps:
Access to the affected area: An incision is made to gain access to the affected muscle group and surrounding tissue. The incision may vary depending on the location of the affected area and the individual needs of the patient.
Identification and preparation of the affected structures: The damaged or non-functional muscle group as well as other affected structures such as tendons or nerves are identified and prepared. This may include removing scar tissue or inflamed tissue.
Preparation of the donor muscle or tendon: A healthy muscle with the corresponding tendon is selected and prepared to serve as a replacement for the damaged muscle group.
Rearrangement of the donor muscle or tendon: The prepared tendon is relocated to the attachment site of the damaged muscle group and attached there. This may mean passing the donor muscle through a new tunnel or attaching it to another muscle or bone to take over its function.
Donor tendon fixation: The relocated donor tendon is secured to its new location using special sutures, staples, screws, or other fixation devices.
Wound closure and dressing: After motor replacement surgery is completed, the wound is sutured and a bandage is applied to support healing.
After surgery, rehabilitation and physical therapy are usually necessary to restore mobility, strength and function to the affected limb. The exact rehabilitation plan depends on the type of motor replacement surgery and the individual needs of the patient.
Dupuytren's disease
Dupuytren's disease, also known as Dupuytren's contracture, is a condition of the hand in which the connective tissue in the palm and fingers thickens and shortens. This often results in gradual flexion of the fingers, particularly the ring finger and little finger.
The exact cause of Dupuytren's disease is not fully understood, but it is thought that genetic factors may play a role. The condition is more common in men over 40 years of age and may be associated with other medical conditions such as diabetes.
The symptoms of Dupuytren's disease develop slowly over a period of months or years. Initially, a thickening or nodule formation may be noticed in the palm of the hand. Over time, these knots can develop into solid strands that extend along the fingers. This leads to gradual flexion of the fingers, which can affect hand mobility and function.
Diagnosis of Dupuytren's disease is usually made through physical examination and medical history. In some cases, imaging tests such as ultrasound or magnetic resonance imaging (MRI) may be used to assess the degree of connective tissue involvement.
Treatment for Dupuytren's disease depends on the severity of the disease. In early stages, when symptoms are mild, conservative treatment such as physical therapy or wearing special hand braces to improve finger position may be recommended.
In advanced cases where flexion of the fingers progresses and affects hand function, surgical treatment may be necessary. The surgery aims to remove or split the thickened connective tissue strands to correct the finger position. In some cases, a skin graft may be necessary to cover the defect after removal of the connective tissue.
Rehabilitation after surgery to treat Dupuytren's disease usually involves physical therapy and hand therapy to restore hand mobility and function.
It is important to see a doctor if you have or suspect symptoms of Dupuytren's disease, as only a professional can make the correct diagnosis and recommend the appropriate treatment.
The surgery to treat Dupuytren's disease is called a fasciotomy or fasciectomy. There are different surgical techniques that can be used depending on the severity of the disease and the individual needs of the patient. Here are some common surgical procedures:
Fasciotomy: This method involves cutting the thickened connective tissue strands in the palm and fingers to correct the flexion of the fingers. The surgeon makes an incision in the palm of the hand and carefully splits the affected connective tissue strands. This allows for improved finger mobility.
Subcutaneous fasciectomy: In this technique, a smaller incision is made in the palm of the hand to remove the thickened connective tissue strands. The surgeon works under the skin to remove affected tissue and improve finger position.
Dermofascial fasciectomy: This method is used when the connective tissue is affected not only in the palm but also in the fingers. The surgeon not only removes the thickened connective tissue, but also some of the skin over the affected strands. A skin graft is then performed to cover the defect.
Segmental aponeurectomy: This technique is used when only certain segments of connective tissue are affected. The surgeon selectively removes the affected segments to improve finger position.
Surgery to treat Dupuytren's disease is usually performed under local or general anesthesia. The exact choice of procedure depends on the severity of the disease, the extent of the connective tissue involvement and the individual needs of the patient.
After surgery, rehabilitation is important to restore mobility and function to the hand. This may include physical therapy and hand therapy, including finger extension and flexion exercises.
It is important to see an experienced hand surgeon to determine the correct surgical method for Dupuytren's disease and to discuss possible risks or complications.
Institute for Plastic and Aesthetic Surgery
Institute for Plastic and Aesthetic Surgery
The Institute for Plastic and Aesthetic Surgery at the Glückstadt Clinic deals with functional, cosmetic, shape-changing and reconstructive procedures.
In this area, surgical procedures are performed for both aesthetic and functional reasons.
In order to work as a doctor in this field in Germany, you must complete training as a specialist in plastic and aesthetic surgery.
Dr. med. Florian Bönke
Head of Plastic and Aesthetic Surgery
Career
After completing his medical studies at the University of Kiel, Dr. Bönke initially worked there and completed basic surgical training in cardiac and vascular surgery at the Schleswig-Holstein University Hospital in Kiel. In 2015, he then switched to the clinic for plastic and hand surgery with a center for severe burns at the St. Georg Hospital in Leipzig. In 2017 he followed Prof. Dragu to the University Hospital in Dresden, where he played a key role in founding the Department of Plastic and Hand Surgery, where he most recently worked as senior physician. Since 2023 Dr. Bönke leads together with Prof. Dr. Said the Institute for Plastic and Aesthetic Surgery at Glückstadt Hospital.
Since 2015 Dr. Bönke works exclusively in plastic and aesthetic surgery. In addition to the reconstruction and restoration of the body shape using free tissue transfer and hand surgery, he specialized in body shaping and tightening operations after weight loss.
Dr. Bönke is a specialist in plastic and aesthetic surgery and a member of the German Society for Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC). He also has an additional qualification in hand surgery.
Indications
Abdominoplasty / tummy tuck
thigh lift
upper arm lift
body lift
liposuction
Liposuction for lipoedema
scar corrections
Local flaps
(Free flap plastics)
Hand Surgery:
Secondary tendon reconstruction
Tendon transfer / tendon rearrangement
Nerve sutures / nerve reconstruction / nerve transplant
Annular ligament release in tendovaginitis stenosans (snap fingers)
extensor tendon cleavage
Nerve decompression (e.g. carpal tunnel, loge de gyon, sulcus ulnaris)
Ganglion
M. Dupuytren
