Complications of hand surgery
Surgeons hate complications as much as patients do, but both parties must accept there is always risk in surgery. While a hand surgeon can be judged by his complication rate, equally important is how he deals with any problems.
Dr Rider's approach:
Recognise the complication has happened
It may be human nature to deny a problem, but that doesn't help fix it. Note that this is not the same as admitting error or liability. Many problems "just happen", due to chance or biology. Only occasionally is there a surgical error, or indeed a patient error (such as removing splints).
Make a plan
This may include additional hand therapy, frequent dressing changes, or re-operation. The plan may be "wait and see". Sometimes it is best to delay surgery; the body has an amazing ability to heal itself. Surgeons refer to this approach as "masterful inactivity"; it is occasionally difficult to persist with this in the face of our own instincts (and pressure from the patient) to do something. Experience has taught me it is often the wisest plan.
Provide reassurance that the eventual outcome is usually good
Provide intensive support until the problem is resolved
Some problems are listed below. Fortunately, major complications are very rare in hand surgery.
- Tight dressings/plaster cast
- Stitch abscess
- Delayed healing
- Poor scars
- Injury to deep structures such as nerves
- Chronic Regional Pain Syndrome
- Complications of anaesthesia
See also post-operative directions.