In short. Why the hand needs specialist care, the injuries and conditions a plastic surgeon treats, why tendon and nerve repair follow strict rules, and when a hand problem needs urgent review.
Key points
- A good repair can still produce a stiff, poorly functioning hand if rehabilitation is not followed.
- Splinting, controlled exercise and scar management are part of the treatment, not an optional extra.
The hand is a demanding place to operate. Its skin is thin, there is little spare tissue to close a wound with, and the structures that make it work lie close together in a small space. Tendons glide through tight tunnels and lose their movement if they become stuck to a scar. Nerves run close to the surface where they are easily cut. The small joints stiffen quickly if held still for too long. In the hand, a scar that contracts costs function rather than appearance, and a delay of a few days can change what is recoverable.
Problems a plastic surgeon treats
Common hand problems include cuts and crush injuries, fingertip injuries, tendon lacerations, nerve injuries, retained foreign bodies, and infections of the finger pulp or tendon sheath. Beyond injuries, a plastic surgeon also treats ganglion cysts, trigger finger and simple lumps of the hand and wrist, as well as scars and contractures that limit movement. Fingertip injuries deserve particular mention: they are common, painful, and the choice between healing by dressing, a graft or a small flap depends on how much tissue is lost. Infection in the tendon sheath is a surgical emergency, because a tendon can lose its glide permanently if it is not cleared promptly.
Why tendon and nerve repair follow strict rules
A cut tendon is repaired early where possible, because the ends retract and the gap becomes harder to close with time. After repair the tendon must be protected while it heals, but not by complete rest: controlled movement through a defined range keeps it gliding while the repair gains strength, which is why splinting and hand therapy are prescribed so precisely. Nerve repair follows a different timetable. A nerve regrows slowly, and recovery is measured in months rather than weeks. Sensation and strength may return only partly, depending on the nerve involved, the level of injury and the delay before repair.
Why hand therapy matters as much as surgery
A good repair can still produce a stiff, poorly functioning hand if rehabilitation is not followed. Splinting, controlled exercise and scar management are part of the treatment, not an optional extra.
Realistic expectations and red flags
After a significant hand injury, stiffness, reduced grip strength, cold sensitivity and a scar that remains tender are all common. Some improve over many months; others may persist. Recovery is often measured over a year or more, and full return to the previous level of use is not guaranteed.
Some hand problems should not wait for a routine appointment. A hand becoming swollen, red and increasingly painful, a finger that will not straighten or bend, a wound that will not stop bleeding, or any loss of sensation or movement after an injury needs urgent review. Prompt assessment protects function that may not be recoverable later.
Seek urgent review if
- A finger or the hand is swollen, red and increasingly painful, or you have a fever.
- You cannot bend or straighten a finger, or a wound will not stop bleeding.
- There is numbness, tingling, or loss of movement after a hand injury.
Frequently asked questions
Why is the hand such a demanding place to operate on?
Its skin is thin, there is little spare tissue to close a wound with, and the structures that make it work lie close together in a small space. Tendons glide through tight tunnels and lose movement if they stick to scar, nerves run close to the surface, and the small joints stiffen quickly if held still.
Why must a cut tendon be repaired early?
The tendon ends retract and the gap becomes harder to close with time. After repair the tendon is protected while it heals, but not by complete rest: controlled movement through a defined range keeps it gliding while the repair gains strength, which is why splinting and hand therapy are prescribed so precisely.
Is full recovery guaranteed after a significant hand injury?
No. Stiffness, reduced grip strength, cold sensitivity and a scar that remains tender are all common. Some improve over many months and others persist. Recovery is often measured over a year or more, and full return to the previous level of use is not guaranteed.
Risks & Limitations
- Reconstruction is usually staged — more than one operation is normal, and the plan may change as healing progresses.
- Donor-site scarring and discomfort, including after rib cartilage harvest.
- Partial or complete failure of a flap or graft, which may require further surgery.
- Scars are permanent. They mature and fade but never disappear.
- Asymmetry and the inherent limits of matching a normal side.
- Altered sensation, numbness or weakness in the operated area.
- Contracture, which may need release procedures later.
- Final assessment is made at 6–12 months, and longer in growing children.
When to Seek Care
- A flap or graft that turns dark, cold, black or stops bleeding when pricked.
- Fever above 38 °C, or spreading redness, warmth or discharge around a wound.
- New or worsening pain, swelling or fluid leakage from the operative site.
- Bleeding that does not stop with gentle pressure.
- Any change in a reconstructed area that concerns you, however minor.
References & Further Reading
- American Society of Plastic Surgeons (ASPS) — reconstructive surgery guidance
- World Health Organization (WHO) — burn and trauma care resources
- Chinese Medical Association, Plastic Surgery Branch — clinical guidance
- Cochrane Library — systematic reviews in wound and reconstructive care
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.