Hand Surgery and Recostructive Microsurgery

Istituto Ortopedico Galeazzi

key figures 

CLINICAL SERVICES:

  • Hand Surgery 
  • Upper Limb Surgery
  • Reconstructive Surgery of Peripheral Nerves
  • Reconstructive Surgery of the Brachial Plexus
  • Congenital Limbs Malformations Surgery
  • “Pain surgery”

PROCEDURES PERFORMED PER YEAR: 

  • 1.500 surgical procedures 
  • 4.000 specialist consultations

Founded in 2002, the II Hand and Reconstructive Microsurgery Unit of the Galeazzi Orthopaedic Research Hospital in Milan has always represented a point of reference for the treatment of pathologies concerning the upper limbs, peripheral nerves, brachial plexus, as well as congenital limbs malformations. Reconstructive microsurgery techniques are applied to the treatment of all pathologies.

treatmentS

Hand and Upper Limb Surgery 

Main pathologies treated: 

  • Carpal tunnel syndrome
  • Tenosynovitis of the hand flexor tendons
  • De Quervain's disease 
  • Rhizarthrosis and other kinds of wrist and hand arthrosis 
  • Dupuytren's disease
  • Wrist surgery (ligament injuries, tendon injuries, arthroplasty, arthrodesis, Kienbock disease surgery)
  • Elbow surgery (epicondylitis medial and lateral, bicipital and tricipital tendon injuries, ligament injuries, chondroplasty)
  • Fractures: 
    • Wrist 
    • Forearm
    • Metacarpal bones 
    • Hand phalanges 
  • Fracture and pseudoarthrosis of the carpal scaphoid 

Reconstructive Surgery of Peripheral Nerves and Brachial Plexus

The Hand and Reconstructive Microsurgery Unit deals with pathologies of peripheral nerves of the upper and lower limbs and of the brachial plexus, treating these lesions by microsurgical neurolysis and nerve transplantation. The Unit performs functional surgery of the nerve palsy outcomes by tendons and muscles transplantation and transfers. Reconstructive surgery is the solution for the loss of nervous substance, and requires preparation and transfer of simple and complex cutaneous, fascia and muscular flaps of the upper and lower limbs. Lesions of the peripheral nerves can also result in the chronic neuropathic pain which can be treated surgically, the traumatic neuroma by neurolysis, and nerve transplantation. Sometimes there is need to cover the nervous lesion by a simple or complex flap (“pain surgery”).

Particular attention is paid to the therapy of peripheral nerve lesions and brachial plexus in both compression and traumatic lesions. The peripheral nerves are released through the microsurgical neurolysis technique. The brachial plexus is also subjected to microsurgical decompression in the Supraclavicular region of the neck, subclavian region on the thorax and axillary region in Thoracic Outlet syndrome (TOS). In traumatic lesions of the brachial plexus and peripheral nerves, microsurgical repair by nerve grafts taken from the sural nerve and other available nerves and sutured with microsurgical wires by the operator microscope. It is a very refined and difficult surgery that requires many years of training and experience.  

Arthrosis and arthritis

For patients suffering from arthrosis and rheumatoid arthritis, the Unit offers joint repair treatments and techniques by total and partial prosthesis implantation (both wrist and hand prosthesis). Istituto Ortopedico Galeazzi’s Hand and Microsurgery Unit is also particularly skilled in the implantation of total and partial elbow prostheses.

Congenital Limb Malformations Treatment

Repair of congenital limbs malformation entails a very complex surgical skill because it requires the contemporary knowledge of techniques of plastic and orthopaedic surgery. Indeed, these are very complex malformations in which the patient needs skin corrections using zeta plastics and cutaneous flaps, the correction of the skeleton by osteotomies and bone grafts, leading to the functional correction by muscle and tendinous transfers. 

Main Pathologies Treated:

  • Syndactyly
  • Polydactyly
  • Camptodactyly
  • Congenital club hand
  • Arthrogryposis

Innovative therapies and Research

The Unit performs procedures for joint infiltration with hematopoietic cells and abdominal fat. Nowadays, many turn to cellular therapy: the use of stem cells that are taken from the abdominal fat, suitably centrifuged and isolated and injected into the arthrosis joints of the hands, particularly in the cases of arthritis of the thumb, wrist and elbow. In addition, the same stem cells can be injected around the damaged peripheral nerves in order to reduce chronic neuropathic pain. These innovative therapies will become common in the near future.

 

NOTABLE ADVANCED TECHNOLOGICAL EQUIPMENT

  • X-ray fluoroscopic system
  • Echography 
  • CT Scan
  • Nuclear Magnetic Resonance (NMR)
  • Operator microscope