Let’s help out. This is the appeal of the Italian Society of Hand Surgery which has just promoted a National Day of awareness and prevention on pathologies and traumas of the upper limb. Diseases affecting the hand are becoming increasingly important in our communities with high functional demands, especially in the workplace, and in our society in general. Hand trauma is the first cause of absence from work, although the most obvious problem is represented by trauma during daily activities (domestic trauma, accidents involving children).
Domestic trauma is also on the rise
And unfortunately, the traumas related to recreational activities such as gardening or other activities that take place at home and which sometimes also involve the amputation of segments that can only be reconstructed in highly specialized centers are also increasing. Equally relevant are currently non-acute pathologies (among all arthrosis, carpal tunnel syndrome) which cause important functional difficulties in carrying out daily activities. To enter this complex universe of possibilities and limits represented by the hand, we let ourselves be guided by the doctor Maddalena Bertolini (Orthopedics and Traumatology II with specialization in Hand Surgery, Cto of Turin), leading figure for hand surgery and reconstructive microsurgery for complex and microsurgical lesions in urgency and in election. He is also a director of the Italian Society of Hand Surgery.
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by Rory Cappelli
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Doctor Bertolini, why can the hand be considered a complex structure and why do we tend to ignore this complexity?
“The hand has a complex structure because it contains many structures in a small space, it is the part of the body with the most complex anatomy, there are more than twenty tendons, nerves, arteries, ligaments, all very small and all very close to each other , therefore it is practically impossible to get a hand injury, a wound, and not have damage to any of these structures. Which are sacred, because they are fundamental for functionality. Second problem: all the structures of the hand, in particular the tendons are interconnected with each other. The most important work of the hand is opposition and apprehension, any daily gestures require coordination between the fingers, and since we perform very refined operations with the hands, a damaged finger causes a deficit of the whole hand. One of my classic lessons to students has always been: “potential for serious damage to the minor traumatology of the hand.” In simple terms, if I have a tip injury to the palm, from t aierino, and I can injure both a tendon, a nerve and an artery at the same time. The hand is the extension of our heart and our thoughts, it is the part of our body that we see most often, it is in front of our eyes, it expresses affective gestures, it introduces us into the world, we are so intimate with our hands that the the thought of complexity does not even touch ordinary people who are not familiar with medical issues “.
Does raising awareness among people and the community about hand health also mean prevention with benefits for all?
“Of course, it is a good thing that citizens know what an injury on the hand can entail, because they can understand many things. And it is also essential that they know that we hand professionals exist, this because in the event of trauma or pathologies they will know where to go. And the right place is a center dedicated to the hand. Our masters also said it: whoever first sees a traumatized hand and manages it, is the one who has the greatest impact on the outcome and therefore on the final result. ‘beginning becomes very complex for us to recover. For this reason SICM has created a commission, of which I am president, which is Cumi, coordination of Italian microsurgical emergencies, which deals with accreditation, clearly endorsed by the Italian Society and by the council management, of the Italian centers “.
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What are the most common pathologies and injuries of the hand currently?
“Certainly those at work represent a large part, given the prevalence of the manufacturing industry in Italy. We are in fact working to create a startup to make companies aware of what a hand injury can represent in the long term: it is of very long recovery times, especially for amputations and sub-amputations of the fingers. We exhaust our reconstructive capacities, but then the patient has to face a very long journey, so he stays away from work, does not produce income, etc. Therefore it is important do prevention and information at the company level “.
What are other frequent cases?
“Domestic traumas, especially in children, from fractures to wounds, from tendon injuries to complex traumas, are very difficult to manage and even to rehabilitate. The most common pathologies, on the other hand, are degenerative diseases such as arthrosis of the hands, logically linked to old age, compressions of the nerves, typically the carpal tunnel, compression of the elbow nerve, all childhood malformative pathologies, the results of trauma, tendonitis, tendinopathies such as the famous trigger finger. because hand surgery is systematized in 5 thousand pages “.
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by Maria Teresa Bradascio
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Hand microsurgery intervenes in extremely delicate situations. In the hospital where you work, you have developed state-of-the-art techniques. What is it about?
“Accredited hand surgery centers that also do emergency microsurgery, moving parts of skin or muscles or arteries, or all together, from one part of the body to another. And the donor site following these surgeries does not must have functional or aesthetic deficits. The evolution in this field, however, is not so much linked to robotics. We have sophisticated microscopes that are not so helpful, because what increases the quality of our work are our skills, that is our ability to rebuild more and more things, even by carrying toes to hand or composite flaps from one part of the body to another. Ultimately microsurgery and implants aim for function. A reimplanted hand must work, it must not just survive from the vascular point of view “.
What possibilities does research offer?
“We are talking about reconstructive possibilities and the ability to find solutions to problems that may appear unsolvable. Therefore continuous training makes techniques evolve. We at the CTO have a microsurgery laboratory where young people can practice. Advanced skills are increasingly creative solutions to complex lesions, and to achieve these results training is indispensable. The Italian Society of Hand Surgery, for the fire of passion and without support, offers free training and raises young people in the field of microsurgery. There is no prosthesis that can be equated with a reconstructed hand: we know that the hand is extremely complex and does magical things, just think of what a Rolex watchmaker, a Hermès craftsman, an artist, a musician does with their hands “.
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Based on your experience, are there any steps in hand pathologies that must and can be done before resorting to surgery?
“Yes, there are pathologies that first require a phase with the physiotherapist, with the physiatrist, for an evaluation, or for recovery, or to solve problems, or to reduce pain, after which we intervene if all this is not enough. But more often the opposite happens, that is, we do the surgical part and then the physiatrists and physiotherapists intervene with whom a continuous discussion takes place to take stock of the situation “.