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ELEVATION | CLEANLINESS | PAIN | POST-OPERATION CLINIC VISIT | FOLLOW-UP VISITS | DRIVING | THERAPY | RETURNING TO WORK
Some hand surgery can take as little as 20 minutes, on the other hand some intricate surgery can take much longer – it will depend on what needs to be done. Many of the operations can be performed as day-cases, though this will depend on each individual patient's requirements and the complexity of the case. This section will give you information concerning the non-clinical details associated with the surgical experience.
Most patients who undergo hand surgery will come into hospital on the day of the operation even if they are going to stay in overnight. Providing that you have someone to look after you it is likely that you will be allowed home a few hours after your surgery. You should arrange someone to collect you and, remember, you should travel by car or taxi. You WILL NOT be able to drive yourself and should NOT use public transport. You should also arrange for a responsible adult to stay with you for at least 24 hours after going home. You may be provided with medication, you will be given instruction regarding elevation and any exercises that you are required to do. Depending on the type of surgery, an outpatient appointment may be made or you will be asked to see your Practice Nurse for inspection of the wound or removal of the sutures. Your GP will be informed of your visit to the hospital.
If you follow the instructions you are given when you leave the hospital then your hand is likely to heal more quickly and with fewer complications.
If you are staying overnight on the ward, then your hand may be elevated in a Bradford Sling, which is made of foam. When you go home or if you are a daycase you will be given a sling to help you keep your hand up. This can be used both in the day and at night when you can rig up some other type of support or rest the arm on pillows.
It is very important to keep the hand up as high as possible for the first few days (you will be advised as to how many). This helps to prevent excessive bleeding and swelling and keeps pain to a minimum. Remember to regularly wiggle the fingers within the confines of the bandage - DO NOT GO INTO PAIN - and to move your shoulder and elbow out of the sling to prevent other joint stiffness and complications.
Keeping the hand clean and dry will prevent infection and avoid softening of any Plaster of Paris splints, which may have been applied for support.
For bathing/showering a plastic bag should be secured over dressings – some chemists stock a special bag or ‘aqua-shield’ for this purpose.
Remember that even simple tasks will be difficult if your dominant hand is affected; such as shaving, brushing teeth, applying contact lenses, brushing hair, dressing etc.
Your anaesthetist will advise you on type of medication which will depend upon the operation performed and your general medical condition. A more detailed discussion on anaesthesia and pain relief has been prepared by Dr John Mackenzie. If you are experiencing pain then it is wiser to keep it under control than to be stoic – the pain could end up controlling you. Several of the complications are more likely to occur if pain gets out of control. For the first 48 hours it is better to take regular painkillers to keep up the levels in the body, rather than waiting for the pain to occur. You will be given instructions on who to ring if the pain is not controlled by the medication dispensed. For most simple operations the pain should settle quickly, within 2 - 3 days. If at any stage the pain increases out of proportion to what you might be expecting then you should seek medical attention.
At this visit it is likely that the heavy bandaging will be removed, the wound will be checked, and stitches taken out. You may have an x-ray and you may see the Hand Therapist. It may be that the hand is redressed or plastered for a while longer. All of this depends upon the specifics of the surgery.
At follow-up visits your progress will be monitored and rehabilitative therapy started if necessary. You will be checked until you have made full progress.
It is generally not advised to drive when in a ‘plaster’ although some ‘functional splints' are designed to allow the freedom of movement to drive. The Law is quite clear that following any surgery the key emphasis is that you are SAFE to drive, it is your responsibility to satisfy that requirement, not only because it is the legal duty but also becasue if you do drive and are not safe then your insurance company are likely to invalidate your policy.
The following is an extract from page 7 of the DVLA website.
' Driving after surgery'
Drivers do not need to notify DVLA unless the medical conditions likely to affect safe driving persist for longer than 3 months after the date of surgery (but please see Neurological and Cardiovascular Disorders Sections for exceptions). Therefore, licence holders wishing to drive after surgery should establish with their own doctors when it is safe to do so. Any decision regarding returning to driving must take into account several issues. These include recovery from the surgical procedure, recovery from anaesthesia the, distracting effect of pain, impairment due to analgesia (sedation and cognitive impairment), as well as any physical restrictions due to the surgery, underlying condition, or other co-morbid conditions.
It is the responsibility of the driver to ensure that he/she is in control of the vehicle at all times and to be able to demonstrate that is so, if stopped by the police. Drivers should check their insurance policy before returning to drive after surgery.
General physiotherapy will be undertaken at your local physiotherapy centre (this may be a local hospital, your GP surgery or a Private clinic). If you require more specialist Hand Therapy then you will most likely be referred to a specialist Hand Therapist (see Contacts).
It is important to give the limb time to heal and recover from the surgical insult. Some structures take longer to heal than others and it is important that 'things' aren’t rushed by a hasty return to work, especially if it is heavy/manual work. You can obtain a ‘sick certificate’ either from hospital (on the day of surgery) or from the clinic or your GP to cover your absence from work. However, it is also important that you do not ‘over-protect’ the hand to the point of not using it at all – this can have disastrous results and can lead to long-term dysfunction. Follow the advice given to you after surgery, at the clinic and by the therapist.