Post Operative Complications Miss Meg Birks Consultant Hand Surgeon GP Education event 1 st March 2012

Immediate Complications Bleeding –Apply direct pressure –Elevate the hand –If not stopped after 20-30min contact the Sheffield Hand Centre (SHC), Surgical Assessment Centre or Emergency Department

Early Complications Infection –Unusual –If metalwork in situ refer back to SHC –If soft tissue procedure then treat empirically with oral antibiotics (staph cover) –If patient unwell refer back to SHC or Emergency Department

Early Complications Wound dehiscence –Redress the wound –Refer back to SHC for assessment –Depending on time since procedure, site, surgery and patient factors the wound may be sutured or left to heal by secondary intention

Short to Medium Term Complications Swelling –Elevate the hand –Move the fingers as much as the post operative instructions allow –Consider referral back to SHC for hand therapy (pressure garments & other modalities)

Medium Term Complications Stiffness (Assuming no post operative restrictions) –Encourage active and passive movement of the fingers, thumb and wrist –Consider referral back to SHC for hand therapy as this can be very beneficial

Medium to Long Term Complications Complex Regional Pain Syndrome (CRPS) –Also known as Reflex Sympathetic Dystrophy (RSD), Sudek’s Atrophy and Allodynia –Difficult and poorly understood –Best prognosis is from prompt diagnosis and hand therapy

Medium to Long Term Complications CRPS features –Excessive pain with no other complications –Vasomotor symptoms (sweating, colour change, swelling) –Stiffness –Increased hair/nail growth

Medium to Long Term Complications CRPS treatment –Comprehensive conventional oral regime –+/- Amitriptyline 5-10mg nocte –Pain Clinic –Hand Therapy (for mirror box therapy, oedema control, mobilisation and rehabilitation)

Any Questions?