Risk and Complications
Swelling
Swelling is common in the operated area and is normal after the operation.
Elevating your hand and moving your fingers will help keep swelling down.
If the swelling increases and the affected area looks red, this may indicate an infection. If you suspect you are developing an infection,
you should contact your General Practitioner or the Hand Clinic.
We will show you some simple exercises to help reduce the swelling and simple instructions to follow post-operatively
Bruising
Bruising is common and normal after operations. There may be some minor seepage from your wound following the surgery and this will settle over time. The bruising is likely to track with gravity and if you have kept you hand elevated it may appear towards the elbow.
Bleeding (and patients on anti-coagulation or anti-platelet medications)
If you are on anticoagulation you will be given a tailored plan regarding your medication in the perioperative period.
See here for further information from the British Society of Haematologists regarding peri-operative management of anticoagulation and antiplatelet therapy
If you experience steady bleeding from your wound, elevate your hand and press on the wound to stop the bleeding. If it does not
stop, depending on the severity of the bleed, contact your General Practitioner, local Accident and Emergency or the Hand Clinic.
Infection
Superficial infections are common (<5%) after hand surgery and cause redness, swelling, pain and pus around the stitches.
Smoking increases the risk of significant infection 4-5 times the normal rate. For operations involving skin & bone grafts or complex reconstruction your surgery may be delayed until you have stopped smoking. Smoking cessation advice can be found here on the NHS living well website
Most infections tend to settle quickly with oral antibiotics and regular dressings.
For superficial wound inflammation and light infection with skin bugs regular washing under a stream of warm tap water can in fact reduce the need for antibiotic treatment, we will advise you at the nurse led dressing clinics.
Deep infections around the tendons and bones are very rare and may need admission to hospital for intravenous antibiotics and further
surgery. These can cause longer-term complications, such as stiffness.
Scarring
Every operation leaves scars. It is widely known that smoking increases scarring and should be avoided.
Your scar may initially be tender and thickened. It should soften and become more comfortable with time. Firm massage should help the
scar improve. This can take up to 6 months for extensive operations for dupuytrens contracture and after fracture fixation.
Your scar may be numb permanently.
You will be provided you with information about hand care after surgery and receive formal hand therapy instructions.
You can find advice regarding scar desensitisation here
Delayed wound healing
Your wound will heal with dressings but may take a few weeks to heal completely.
Sometimes the wound splits open or takes longer to heal. The reasons for this may include smoking, infection, bleeding or poor blood supply to the wound edges. Traumatic wound can take longer to heal and sometime are left to heal by themselves.
Stiffness
Stiffness may be due to swelling, scar tissue or immobility. It can be made worse by smoking, infection or other complications. You can help to avoid stiffness by keeping your fingers moving after your surgery.
Please follow these simple exercises to keep your hand moving.
Damage to adjacent structures
Other nerves, vessels and structures could be inadvertently damaged during the operation. This is more common in operations
that occur after trauma or when there is a lot of scar tissue at the site of the surgery.
Mr Jeffers will using either magnifying loupes or a microscope to reduce the risk. Inadvertent damage is rare and can be repaired at the time the damage occurs. However, there may be a period of numbness or poorer blood flow whilst the repair heals.
Cold intolerance
Cold intolerance is very common after procedures on your finger but the reason for this is not clear. It is worse in those who smoke, have diabetes, vascular disease or inflammatory conditions (such as Rheumatoid arthritis, vasculitis or lupus).
It develops over the first three months following surgery and may remain fairly constant over the first 12 months. It may improve over
subsequent years but rarely resolves completely.
This may cause you difficulty working in cold environments. You can protect your hands from both wind-chill and cold by wearing
insulated gloves.
Thromboembolism
The risk of deep vein thrombosis (DVT) and pulmonary embolism during hand surgery peri-operative period is extremely low. We will undertake a personalised risk assessment to see if you require any mechanical (stockings or calf pumps) or pharmaceutical (anti-coagulants) during your peri-operative period.
Most patients do not need any specific treatment, as most operations are relatively short, often under local or regional block anaesthetic, the patient is rapidly mobile post-operatively and they are not on the lower limb limbs.
Professor David Warwick, a senior hand surgeon, undertook a risk assessment and published it here on behalf of the BSSH.
Complex Regional Pain Syndrome (CRPS)
This is a chronic pain syndrome that causes pain, stiffness and swelling which are out of proportion to the surgery.
Risk factors include nerve injury, smoking, poor circulation, traumatic injury, and autoimmiune conditions.
The pain may be experienced as severe with burning and like an electric shock. If the pain is not controlled by simple painkillers, contact the Hand Clinic.
Mild CRPS occurs in 5% of patients and will have good resolution.
Severe cases (< 1 in 1000 -10000) are very rare but may leave the hand permanently stiff and swollen.
Further information about CRPS can be found on the NHS website, if you are unfortunate to be affected you will be urgently referred to our Senior Hand Therapist, The Pain Clinic (staffed by our Consultant Anaesthetist) and prescribed pain killers and nerve modulating drugs (which you GP can increase in time).
The BSSH and Royal College of Physicians CRPS guidelines are found here
Swelling
Swelling is common in the operated area and is normal after the operation.
Elevating your hand and moving your fingers will help keep swelling down.
If the swelling increases and the affected area looks red, this may indicate an infection. If you suspect you are developing an infection,
you should contact your General Practitioner or the Hand Clinic.
We will show you some simple exercises to help reduce the swelling and simple instructions to follow post-operatively
Bruising
Bruising is common and normal after operations. There may be some minor seepage from your wound following the surgery and this will settle over time. The bruising is likely to track with gravity and if you have kept you hand elevated it may appear towards the elbow.
Bleeding (and patients on anti-coagulation or anti-platelet medications)
If you are on anticoagulation you will be given a tailored plan regarding your medication in the perioperative period.
See here for further information from the British Society of Haematologists regarding peri-operative management of anticoagulation and antiplatelet therapy
If you experience steady bleeding from your wound, elevate your hand and press on the wound to stop the bleeding. If it does not
stop, depending on the severity of the bleed, contact your General Practitioner, local Accident and Emergency or the Hand Clinic.
Infection
Superficial infections are common (<5%) after hand surgery and cause redness, swelling, pain and pus around the stitches.
Smoking increases the risk of significant infection 4-5 times the normal rate. For operations involving skin & bone grafts or complex reconstruction your surgery may be delayed until you have stopped smoking. Smoking cessation advice can be found here on the NHS living well website
Most infections tend to settle quickly with oral antibiotics and regular dressings.
For superficial wound inflammation and light infection with skin bugs regular washing under a stream of warm tap water can in fact reduce the need for antibiotic treatment, we will advise you at the nurse led dressing clinics.
Deep infections around the tendons and bones are very rare and may need admission to hospital for intravenous antibiotics and further
surgery. These can cause longer-term complications, such as stiffness.
Scarring
Every operation leaves scars. It is widely known that smoking increases scarring and should be avoided.
Your scar may initially be tender and thickened. It should soften and become more comfortable with time. Firm massage should help the
scar improve. This can take up to 6 months for extensive operations for dupuytrens contracture and after fracture fixation.
Your scar may be numb permanently.
You will be provided you with information about hand care after surgery and receive formal hand therapy instructions.
You can find advice regarding scar desensitisation here
Delayed wound healing
Your wound will heal with dressings but may take a few weeks to heal completely.
Sometimes the wound splits open or takes longer to heal. The reasons for this may include smoking, infection, bleeding or poor blood supply to the wound edges. Traumatic wound can take longer to heal and sometime are left to heal by themselves.
Stiffness
Stiffness may be due to swelling, scar tissue or immobility. It can be made worse by smoking, infection or other complications. You can help to avoid stiffness by keeping your fingers moving after your surgery.
Please follow these simple exercises to keep your hand moving.
Damage to adjacent structures
Other nerves, vessels and structures could be inadvertently damaged during the operation. This is more common in operations
that occur after trauma or when there is a lot of scar tissue at the site of the surgery.
Mr Jeffers will using either magnifying loupes or a microscope to reduce the risk. Inadvertent damage is rare and can be repaired at the time the damage occurs. However, there may be a period of numbness or poorer blood flow whilst the repair heals.
Cold intolerance
Cold intolerance is very common after procedures on your finger but the reason for this is not clear. It is worse in those who smoke, have diabetes, vascular disease or inflammatory conditions (such as Rheumatoid arthritis, vasculitis or lupus).
It develops over the first three months following surgery and may remain fairly constant over the first 12 months. It may improve over
subsequent years but rarely resolves completely.
This may cause you difficulty working in cold environments. You can protect your hands from both wind-chill and cold by wearing
insulated gloves.
Thromboembolism
The risk of deep vein thrombosis (DVT) and pulmonary embolism during hand surgery peri-operative period is extremely low. We will undertake a personalised risk assessment to see if you require any mechanical (stockings or calf pumps) or pharmaceutical (anti-coagulants) during your peri-operative period.
Most patients do not need any specific treatment, as most operations are relatively short, often under local or regional block anaesthetic, the patient is rapidly mobile post-operatively and they are not on the lower limb limbs.
Professor David Warwick, a senior hand surgeon, undertook a risk assessment and published it here on behalf of the BSSH.
Complex Regional Pain Syndrome (CRPS)
This is a chronic pain syndrome that causes pain, stiffness and swelling which are out of proportion to the surgery.
Risk factors include nerve injury, smoking, poor circulation, traumatic injury, and autoimmiune conditions.
The pain may be experienced as severe with burning and like an electric shock. If the pain is not controlled by simple painkillers, contact the Hand Clinic.
Mild CRPS occurs in 5% of patients and will have good resolution.
Severe cases (< 1 in 1000 -10000) are very rare but may leave the hand permanently stiff and swollen.
Further information about CRPS can be found on the NHS website, if you are unfortunate to be affected you will be urgently referred to our Senior Hand Therapist, The Pain Clinic (staffed by our Consultant Anaesthetist) and prescribed pain killers and nerve modulating drugs (which you GP can increase in time).
The BSSH and Royal College of Physicians CRPS guidelines are found here
