R Venkataswami MS (Gen), MCh (Plastic), FAMS, FRCS, (Edin) DSc, (Hon)
Head of the Department Apollo's National Institute for Reconstructive Hand Surgery Micro Surgery and Plastic Surgery,
Emeritus Professor in Plastic Surgery,
Tamil Nadu
Dr MGR Medical University
Chennai, India
Formerly Professor and Head of the Department of Plastic Surgery Institute for Research and Rehabilitation of Hand Stanley Medical College and Government Stanley Hospital
Chennai, India
Foreword by Harold E Kleinert
9Foreword
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Surgery of the Injured Hand
© 2009, R Venkataswami
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editor and the publisher.
First Edition: 2009
9788184484717
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset & Packagings Ltd., New Delhi
4Dedication
I have great pleasure in dedicating this book to all those who worked
with me in my journey through the world of Hand Surgery and to
the young aspiring Hand Surgeons
5Contributors
 | Abraham G Thomas MS, MAMS, MCh, FRCS(Glasg) Prof & Head Plastic Surgery, Pondicherry Institute of Medical Sciences Pondicherry, INDIA |  | David Elliot Consultant Hand & Plastic Surgeon St. Andrew's Centre, Woodlands, Woodham Walter Essex – CMG 6LN, UK |
 | Ashok Raj Koul MS, MCh Chief Plastic Surgeon, Sparsh Hospital, Narayana Health City, Bommasandra Industrial Area, Hosur Road Bangalore-560099, Karnataka, INDIA |  | Edward T Mah Senior Consultant Calvary Orthopaedic & Hand Care Centre, 53 Gover Street, North Adelaide, South AUSTRALIA – 5006 |
 | G Balakrishnan MS, MCh (Plastic) Professor Emeritus, the Tamil Nadu Dr MGR Medical University, Formerly Professor and Head, Institute of Research and Rehabilitation of Hand & Department of Plastic Surgery, Government Stanley Medical College, Chennai. Medical Director, Right Hospitals, No.1, Prof Subramaniam Street, Kilpauk, Chennai - 600 010, INDIA |  | Fu-Chan Wei MD, FACS Professor of Plastic Surgery Dean, Medical College Chang Gung University Chang Gung Memorial Hospital, 199 Tun Hwa North Road Taipei 105, Taiwan, ROC |
 | Roberto M Cavallazzi MD, FIt SSH Formerly Responsible for Hand Surgery in Legnano Hospital Consultant in Hand Surgery and Microsurgery Clinica S Maria - Multimedica Castellanza (VA) - ITALY |  | Guy Foucher Professor of Hand Surgery at the University of Las Palmas de Gran Canaria |
 | Christophe Oberlin MD Hospital Bichat, Orthopaedic, 46 Rue Henri Huchard, 75018 Paris, FRANCE |  | Harold E Kleinert MD Clinical Professor of Surgery University of Louisville School of Medicine, Clinical Professor of Surgery Indiana University-Purdue University School of Medicine Kleinert, Kutz and Associates Hand Care Center, 225 Abraham Flexner Way #700 Louisville, KY 40202, USA |
 | Lam-Chuan Teoh FAMS, MBBS, M Med (Surg), FRCS (Glas) Clinical Assoc Professor, National University of Singapore Senior Consultant Hand Surgeon, Dept. of Hand Surgery, Singapore General Hospital Outram Road, SINGAPORE–169 608 |  | V Nagaswamy MD, DA Formerly Senior Anaesthetist Stanley Medical College, Chennai, South India, 1, 13th Jagadambal Street, T. Nagar, Chennai – 600 017, INDIA |
 | Lorea SOS Main Strasbourg, Consultant at the University of Strasbourg. |  | Pajardi Professor of Plastic Surgery at the University of Milan |
 | Luis R Scheker MD Associate Clinical Professor of Surgery (Plastic and Reconstructive) University of Louisville School of Medicine, Assistant Consulting Professor of Surgery, Duke University Medical Center, Kleinert, Kutz and Associates Hand Care Center, PLLC 225 Abraham Flexner Way, #700, Louisville, KY 40202, USA |  | Praveen Anand MD, FRCP Peripheral Neuropathy Unit, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK |
 | Massimo DEL BENE Hand and Plastic Surgery Dept. Legnano Hospital, 20025 LEGNANO (MI), ITALY |  | Pier Luigi Raimondi Hand Surgery Dept. Casa di Cura Santa Maria - Multimedica, Viale Piemonte, 70 - Castellanza (VA) ITALY |
 | Michael EL Leow BSc, MSc, Cert Prosthetics (Northwestern University), Chief Prosthetist, Department of Hand and Reconstructive Microsurgery National University Hospital, 5 Lower Kent Ridge Road, SINGAPORE – 119074 |  | V Purushothaman MS, MCh Senior Consultant in Hand Plastic and Microsurgery, Apollo First Med Hospital, Chennai, South India. AA-55, 2nd Street, Anna Nagar, Chennai-600 040, INDIA |
 | Michael A Tonkin MD, FRACS, FRCS (Ed Orth) Professor of Hand Surgery Department of Hand Surgery and Peripheral Nerve Surgery University of Sydney, Royal North Shore Hospital St. Leonards NSW 2065, AUSTRALIA |  | S Raja Sabapathy MS, FRCS., M Ch (Plastic), DNB (Plastic) Head, Dept of Plastic, Hand & Micro Surgery, Ganga Hospital, Swarnambika Layout Coimbatore - 641009, INDIA |
 | S Rajasekaran MS, MCh Head of the Department of Orthopaedic Surgery, Ganga Hospital, Coimbatore - 641009 INDIA |  | H Srinivasan MBBS, FRCS (Eng), FRCS (Edin) Formerly Senior Orthopaedic Surgeon, Central Kleprosy Teaching & Research Institute, Chingleput (Tamil Nadu) Present address: “Beach Residency” New No. 25, First Seaward Road, Valmiki Nagar, Chennai - 600 041, India |
 | Richard D Lawson FRACS Consultant Hand Surgeon Department of Hand Surgery and Peripheral Nerve Surgery University of Sydney, Royal North Shore Hospital St. Leonards NSW 2065, AUSTRALIA |  | Sunil Thirkannad MBBS, MS Orth., DNB Orth Attending Hand Surgeon, Kleinert-Kutz Hand Care Center Faculty, Christine M. Kleinert Institute for Hand and Microsurgery Assistant Clinical Professor of Hand Surgery, University of Louisville |
 | Robert WH Pho MBBS, MD (Syd), FRCS (Edin) Professor, Department of Orthopedic Surgery. National University of Singapore, and Senior Consultant, Department of Hand and Reconstructive Microsurgery National University Hospital, 5 Lower Kent Ridge Road, SINGAPORE – 119074 |  | Tsu-Min Tsai MD Clinical Professor of Orthopaedic Surgery University of Louisville School of Medicine Christine Kleinert Institute for Hand and Microsurgery 225 Abraham Flexner Way, #700 Louisville, KY 40202, USA |
 | N Sekar, MS, MCh (Vascular) Formerly Prof and HoD, Vascular Surgery, Madras Medical College, Senior Consultant Vascular Surgeon, Apollo Hospitals, Chennai, INDIA |  | Venkat Ramakrishnan MS (Gen Surg), FRACS (Plastic), FRCS (Eng) Senior Consultant, St. Andrew's Centre for Burns and Plastic Surgery, Broomsfield hospital, Chemsford, ESSEX, UK |
 | Simo K Vilkki MD Head, Department of Hand and Micro Surgery, Tampere University Hospital FIN-33521 Tampere, Finland |  | R Venkataswami MS (Gen) MCh (Plastic), FAMS, FRCS, (Edin) DSc (Hon) Head of the Department Apollo's National Institute for Reconstructive Hand Surgery, Micro Surgery and Plastic Surgery, Emeritus Professor in Plastic Surgery, Tami Nadu Dr MGR Medical University, Chennai, India. Formerly Professor and Head of the Department of Plastic Surgery and Institute for Research and Rehabilitation of hand Stanley Medical College and Government Stanley Hospital, Chennai, India. Resi: No 2/99, Dr Alagappa Road, Chennai - 600 084, INDIA |
 | K Sridhar MS, MCh (Plastic) Consultant Plastic Surgeon Apollo Hospitals, Chennai – 600006, INDIA. |  | Wayne A Morrison Department of Hand and Microsurgery, University of Hand and Microsurgery, Director Bernard O'Brien Institute of Microsurgery, St. Vincents Hospital, Melbourne, 42, Fitzroy Street, Victoria 3065, AUSTRALIA |
 | William C Pederson MD, FACS President and Fellowship Director The Hand Center of San Antonio and Associate Clinical Professor Departments of Surgery and Orthopaedic Surgery The University of Texas Health Science Center at San Antonio San Antonio, Texas, USA |  | Yue Onn Ng Calvary Orthopaedic & Hand Care Centre, 53 Gover Street, North Adelaide, South Australia–5006. |
Surgery of the Injured Hand Towards Functional Restoration presents the multitude of problems and searches for excellence in solutions. A text of international cooperation with 48 chapters by leading surgeons from around the globe stresses surgical team work. Trauma, vascular, neurological, orthopaedic, plastic and general reconstructive principles from the cervical spine to the fingers are authored by renowned surgeons from many continents.
R Venkataswami has edited an all-inclusive volume on hand surgery. He is the senior hand surgeon of the world's most populous hand center, where rich and poor receive the highest standard hand care and reconstruction without regard to the workers’ often meager resources — to me one of the “seven wonders of the world.” This text should be considered essential for upper extremity practicing surgeons and students.
Harold E Kleinert md
Clinical Professor of Surgery
University of Louisville School of Medicine,
Clinical Professor of Surgery
Indiana University-Purdue University School of Medicine
Kleinert, Kutz and Associates Hand Care Center,
225 Abraham Flexner Way #700
Louisville, KY 40202, USA
10Preface
There are innumerable books on ‘Hand Injuries’. Yet, I venture to edit another book. I wanted the experience of several surgeons of long standing in the field of hand surgery to give out their experience in detail in the restoration of function following trauma.
Most of the books place several options before the reader who may be a postgraduate student or a junior surgeon or a senior surgeon. But I thought it is better to bring out the method followed by the respective surgeons who have found out their method giving good results based on their long experience. That means a surgeon should give all details of operative technique and the step-by-step postoperative management of that method. If necessary, the surgeon will touch upon other options. The stress is more on postoperative rehabilitation where most of the books lack details for a student or a junior surgeon to follow with ease. With this in view, the book was planned and approach was made to invite several surgeons across the globe.
Since not many books on hand surgery have come out from India, it was decided to get as many authors as possible from this part of the world.
Certainly, the problems and the approach to these problems differ widely due to several factors particularly socio-economic issues. The treatment modality may be the same but it has to be moulded into the indigenous conditions.
It is not possible to cover every aspect of the hand trauma in a single book. Hence, common problems have been taken up and these chapters are written mostly by well-known authors who have established their credentials.
The problem of including multiple authors in getting them ready in time is well known for many who venture to edit a book. It has taken a pretty long time from the time of its original inception. At last, it has taken a shape and I am happy to place this book in the hand surgery map. I do hope the experience of several doyens in the field will benefit the younger surgeons in particular.
R Venkataswami
11Acknowledgements
I am indeed very thankful to all the authors for their contributions in spite of their heavy professional commitments. I must acknowledge the help of my senior colleague Dr V Purushothaman and Dr Ambat Sabari Girish for their valuable inputs and our secretary Ms J. Bhanu Rekha for her excellent secretarial service in coordinating with the authors and publishers and getting the chapters in time. My special acknowledgement to the publishers for their excellent cooperation.