Hand Surgery

If you're considering hand surgery, a consultation with a plastic surgeon is a good place to start.  Dr Vrtik will examine you, discuss the possible methods of treatment for your problem, and let you know if surgery is warranted. If it is, she will discuss the procedure in detail, including where the surgery will be performed, the anaesthesia and surgical techniques that will be used, possible risks and complications, the recovery and rehabilitation period, and the probable outcome in terms of function and appearance.

Hand Surgery is not just about the surgery. Postoperative wound care and compliance with hand therapy is just as crucial as the surgery itself. The final function outcome of any hand surgery is dependent on these factors:

• Severity and extent of the presenting hand problem
• Timing, choice and execution of the surgery
• Wound healing
• Hand therapy
• Adequate healing time for scar softening and strengthening of tendons/bones

Dr Vrtik’s practice specialises in soft tissue injuries and conditions of the hand and forearm, as well as bony injuries of the hand and fingers. If you have any queries in regards to hand surgery, please do not hesitate to contact us.

What to expect during your consultation

The success and safety of your hand surgery depends very much on your complete frankness during your consultation. You’ll be asked a number of questions about your health, occupation and lifestyle.

Be prepared to discuss:

• Why you want the surgery, your functional requirement and your expectations
• Medical conditions, drug allergies and medical treatments
• Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
• Previous surgeries

Dr Vrtik may also:

• Evaluate your general health status and any pre-existing health conditions or risk factors
• Take photographs for your medical record
• Discuss your options and recommend a course of treatment
• Discuss likely outcomes of the your surgery and any risks or potential complications
• Refer you for further investigations such as blood tests, imaging and scans

If you are having elective hand surgery, at the conclusion of your consultation, our staff will prepare a pre-operative pack for you. This will contain:

• A quote and financial consent for your operation
• Hospital admission information
• Surgical consent forms

This introductory package will either be given to you on the day or sent to you by mail.

The consultation is completely obligation-free. You will not be pressured to proceed with anything you are not comfortable with. Often, if you are unsure, we encourage you to take your time to consider your options; you may want to seek more information and gather a list of specific questions. We may also recommend that you book another appointment to see Dr Vrtik prior to making your final decision. Please do not hesitate to ask our friendly staff for assistance.

If you decide to proceed, bookings for your surgery can be made on the day of your consultation or you could contact us via phone with your decision after you have had a chance to consider your options. Once you have booked in a date, we will help you with your preparations for surgery.

Preparing for surgery

Prior to surgery, you may be asked to:

• Get blood tests or x-rays
• Undergo a medical evaluation by a specialist
• Take certain medications or adjust your current medications
• Stop smoking well in advance of surgery (minimum of 6 weeks +/- urine testing for confirmation)
• Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding

Dr Vrtik only performs hand surgery in accredited private hospitals. Some procedures require hospital stay, and some are performed as Day Surgery. If your procedure is performed on an outpatient basis, be sure to arrange for someone to drive you to and from surgery. For those discharged from Day Surgery after a general anaesthetic, it is essential that you arrange for someone to stay with you for at least the first night following surgery.

Risks and Complications of Hand Surgery

Thousands of successful hand operations are performed each year. While the procedures are generally safe when performed by a qualified and experienced plastic surgeon, complications can arise. In all types of hand surgery, the possible complications include infection, poor healing, loss of feeling or motion, blood clots, and adverse reactions to the anaesthesia. These complications are infrequent, however, and they can generally be treated. You can reduce your risks by choosing a qualified surgeon and by closely following his or her advice.

The decision to have hand surgery is ultimately up to you and you’ll have to decide if the benefits outwiegh the risks and potential complications are acceptable. Dr Vrtik and our staff will explain in detail the risks associated with your surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks and potential complications. Risks specific to each type of procedure will be outlined below.

Most of the risks are very uncommon, and some people (with particular health problems or specific conditions), may be at higher risk for specific complications. Dr Vrtik will discuss this with you during your consultation if any of these risks are specifically pertinent to you. In some situations, it may not be possible to achieve optimal results with a single surgical procedure; revision surgery may be necessary.

Be sure to ask questions: It’s very important to ask questions about your procedure. Don’t be shy about discussing any of your specific concerns with Dr Vrtik or any of our staff members.

During your Recovery and after Hospital Discharge

You will be given detailed instructions on how to care for yourself prior to leaving the hospital. You will also go home with a detailed postoperative brochures specific to your procedure. These will include information on:

• How to care for the surgical site
• Medications to apply or take orally to aid healing and reduce the potential for infection
• Specific concerns to look for at the surgical site or in overall health
• When to see your hand therapist if required (with referral form)
• X-ray form if you require one prior to your follow-up appointment
• How to and when to arrange follow up with our nurse and Dr Vrtik
• Contact numbers in case of concerns or after-hour emergencies

Be sure to ask Dr Vrtik and our nurse specific questions about what you can expect during your individual recovery period:

•  Where will I be taken after my surgery is complete?
• What medication will I be given or prescribed after surgery?
• Will I have dressings/bandages after surgery? When will they be removed?
• Are stitches removed? When?
• When can I resume normal activity and exercise?
• When do I return for follow-up a follow-up appointment?

Following your surgeon’s instructions and compliance with the hand therapist are the key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Avoid getting your wounds and dressings wet unless advised so. Avoid heavy lifting and tasks that require exertion. Exercise should not be undertaken unless discussed with Dr Vrtik or our staff.

Once you are at home, please seek medical attention if:

• You experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately.
• Notice unusual swelling, bleeding, redness, pain, or persistent discharge from your wound
• Become ill, unwell or feverish
• Break out in a persistent rash

Should any of the above occur, you may require hospitalization and additional treatment.

Depending on your procedure and progress, your first routine review appointment with Dr Vrtik is usually at 2-6 weeks. At this appointment, your wound, swelling and hand function is assessed. Further follow-up appointment will be made as appropriate.

Your postoperative period will be fully supported by Dr Vrtik and our staff. If you have any concerns or queries during this period, please do not hesitate to ring our office. If necessary, our Practice Nurse may ask you to come into the office for an assessment earlier than your planned review appointment.

How much does hand surgery cost?

Cost is always a consideration in elective surgery. Prices can vary widely. A surgeon’s cost may vary based on his or her experience, geographic office location and inclusive services.

We have simplified your costs into three components, these are:

• Surgeon’s fee (which is inclusive of surgical assistant fee, routine follow-up appointments, and postoperative dressings)
• Hospital fees
• Anaesthesia fees if you are having a general anaesthetic

Your quote from our practice will only specify the Surgeon’s fee (with above-specified inclusions). We provide you with contact numbers of the hospital and anaesthetist for your procedure – it is your responsibility to check and confirm an agreement on these costs with the relevant parties prior to your booking.

Other costs which are not included in the above may be:

• Hand Therapy
• Prescriptions for medications
• Blood Tests and X-rays as required before or after the operation
• Any revision or emergent surgery required secondary to an unexpected complication

Private health insurance will cover most hand surgery. You will be provided with a medicare item number on your quote, which should also specify the possible rebate you may receive from your private health fund. You should then contact both the hospital and anaesthetist to find out their overall cost and possible rebates you may be eligible for.

If your hand surgery is part of a Worker’s Compensation claim, all above costs will be billed directly to Workcover. You must ensure you have a valid claim number for all your appointments and admissions to hospital. You will also need your claim number for any tests that you may require. If you are have paid for any part of your treatment (e.g. prescriptions) you should keep a receipt and submit a claim to Workcover.

Questions to ask your Plastic Surgeon:

Use this checklist as a guide during your consultation

• Are you a member of the Australian Society of Plastic Surgeons?
•  Were you specifically trained in the field of hand surgery?
• Do you have hospital privileges to perform this procedure? If so, at which hospitals?
• Am I a good candidate for this procedure?
• What will be expected of me to get the best results?
• Would I need to stop any medications or herbal supplements prior to my operation, if so, for how long?
• What surgical technique is recommended for me?
• Where and how will you perform my procedure?
• What should I expect during my recovery and how long would my recovery take?
• What kind of help will I need during my recovery?
• What are the risks and complications associated with my procedure?
• How are complications handled and what additional costs should I expect?
• What are the results I can expect and how would it look over time?
• Am I likely to need further revision surgery in the future?
• What are my options if I am dissatisfied with the outcome of my surgery?

(Some information is courtesy of the American Society for Surgery of the Hand)