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Procedure guide · Reconstructive Plastic Surgery
Hand ReconstructionHand reconstruction restores function after injury, infection or a condition present at birth, repairing tendons, nerves, bone and skin cover. The operation is the smaller half of the treatment: hand therapy several times a week for months is what determines how much movement returns. Stiffness is the enemy, so protected movement starts early, and for that reason this procedure suits travelling poorly.
Hand reconstruction restores function after injury, infection, tumour surgery or a condition present at birth, repairing or replacing tendons, nerves, bone and skin cover. The hand is functionally the densest part of the body: within a few centimetres sit structures that allow pinch, grip, fine manipulation and detailed sensation, and damage to any of them is felt immediately in ordinary life.
The central fact about hand surgery is that the operation is the smaller half of the treatment. A technically perfect tendon repair in a hand that is not moved correctly afterwards binds down in scar and ends stiff, and a stiff hand is frequently worse than the injury that caused it. Hand therapy, several times a week for months, following a protocol matched precisely to what was repaired, is what converts a good operation into a working hand. The difference between patients who do that work and those who do not is larger than the difference between surgical techniques.
Stiffness is therefore the enemy rather than an inconvenience, and modern hand surgery is built around it. The tissue planes that let tendons glide are lost within weeks of immobility, so protected movement begins as early as it safely can. Splints are designed to permit some movement rather than prevent all of it, and the instructions about which movements to perform and which to avoid are precise rather than general: after a tendon repair, some movements are actively encouraged in the first week while others will rupture the repair, and the difference is not intuitive.
Nerve recovery runs on its own timetable and cannot be hurried. Fibres regrow at roughly a millimetre a day from the point of repair, so sensation returning to a fingertip after a repair at the wrist takes many months. Recovery is frequently incomplete, and it is markedly better in children than in older adults. What returns is often altered rather than normal sensation, which is the usual outcome rather than a complication.
Cold intolerance deserves naming because it follows most significant hand injuries and nerve repairs, is extremely common, frequently permanent and almost never mentioned in advance. Patients describe aching, pain and clumsiness in cold weather, sometimes for years. It usually improves somewhat over 2 years and rarely disappears. Gloves and keeping the hand warm help. Knowing it is expected rather than a sign of failure makes it considerably easier to live with.
Timing matters more here than in most reconstruction. Tendons, nerves and joints all do better repaired early than late: a nerve repaired within weeks recovers better than the same nerve grafted a year afterwards, and a joint that has been stiff for months rarely regains full movement. That is one reason acute hand injuries are treated where they happen rather than travelled for, and why late reconstruction is harder, less predictable and frequently limited by what has already stiffened.
Some operations restore what cannot be repaired. A toe can be moved to the hand with its vessels, nerves and tendons to replace a missing thumb, restoring pinch, which is most of what a thumb does. It is major surgery with a foot donor site, and the result is visibly a toe. For thumb loss it is frequently the best functional option available, and in children the transferred digit grows.
The practical conclusion for this site is unambiguous. Hand reconstruction is among the poorest fits for travelling of anything described here, because the therapy that determines the result runs several times a week for months and cannot be delivered from another country. Anyone considering a late reconstruction abroad should arrange and confirm local hand therapy before booking, because without it the operation is unlikely to help.
Hand reconstruction is defined by the fact that the hand is a moving structure packed into a very small space. Tendons glide through sheaths with almost no clearance, nerves and arteries run alongside them, and joints tolerate immobility badly. Scar tissue that would be irrelevant in the thigh sticks a tendon to its sheath in the finger and costs movement permanently. Almost every principle in hand surgery, from the smallest incisions to the earliest possible movement, follows from this single constraint.
Hand reconstruction is planned around what the hand is for rather than around restoring every structure. A guitarist, a surgeon, a bricklayer and a typist each need different things from the same injured hand, and a reconstruction that maximises pinch may not be the one that maximises grip. Good hand surgeons ask detailed questions about work and hobbies before deciding, and patients who describe in specific terms what they need to be able to do get better-targeted plans than those who ask for the hand to be fixed.
Hand reconstruction has a narrow window for nerve and tendon work that closes quietly. A divided tendon retracts and becomes difficult to retrieve after a few weeks. A divided nerve can be repaired directly early, needs a graft later, and after roughly 18 months the muscle it supplied has degenerated beyond recovery, at which point only a tendon transfer will restore movement. Someone who has been told nothing can be done years after an injury may still have options, but they are different and more limited ones.
Hand reconstruction depends on therapy delivered on a specific schedule, and this is the practical reason it travels so poorly. A flexor tendon repair is moved within days under a therapist’s supervision, on a protocol that changes weekly for around 12 weeks. Miss the schedule and the repair either ruptures or scars solid, and both outcomes are difficult to retrieve. Anyone considering hand surgery abroad should confirm in writing who will deliver that therapy at home, and should treat a plan that leaves it vague as incomplete.
Hand reconstruction is built on the thumb, which accounts for roughly 40 per cent of hand function by most assessments. A hand with a working thumb and 2 fingers is considerably more useful than a hand with 4 fingers and no thumb, which is why surgeons will go to extraordinary lengths to preserve or rebuild one, including transferring a toe or repositioning the index finger. Where resources have to be prioritised in a severely injured hand, the thumb comes first.
Hand reconstruction planning distinguishes clearly between restoring a structure and restoring a function, and the 2 do not always coincide. Where a tendon cannot be repaired, a working tendon can be rerouted to do its job, and where a nerve cannot be regenerated in time, a different nerve can be transferred to power the muscle. These transfers trade one function for a more important one, and they widen the options considerably for injuries that are too old for direct repair.
Hand reconstruction recovery is measured in specific, testable terms rather than in general improvement. Grip and pinch strength are measured with a dynamometer, range of movement is recorded joint by joint, and sensation is tested formally. Those numbers guide therapy and identify a plateau, and they are the basis on which further surgery is considered. Patients who see their own measurements tend to engage with therapy more consistently.
Hand reconstruction has consequences for work that should be discussed before rather than after surgery. Manual trades frequently cannot be resumed for 3 to 6 months, and in some cases not at all in the same form. Where an injury is work-related, occupational health involvement early makes a phased return far more likely. This planning is as much a part of the outcome as the operation itself.
Hand reconstruction abroad is occasionally appropriate for a discrete, planned procedure in someone with a stable hand and access to therapy at home, for example a single tendon transfer or a scar release. It is almost never appropriate for acute injuries, complex reconstructions or anything with an intensive early therapy protocol. That distinction is worth applying to any quotation received.
Surgeons look for these points at the consultation.
Hand reconstruction suits people with loss of movement, sensation, skin cover or structure in the hand after injury, infection, tumour or a congenital difference, who are medically fit for the operation, and who can attend hand therapy several times a week for months afterwards.
Reasons a good surgeon will ask you to wait or choose something else.
Hand reconstruction is deferred in active infection until it is controlled, in current smokers for flap surgery, where the blood supply to the hand is inadequate, in unstable medical conditions, and where the patient cannot undertake the therapy without which even a technically perfect repair stiffens into uselessness.
Ask your surgeon which technique they recommend for you and why.
Cut tendons are stitched back together, or where the gap is too great or the injury old, a tendon graft is taken from elsewhere to bridge it.
Divided nerves are stitched together under magnification, or a graft or conduit is used to bridge a gap so fibres can regrow across it.
Local or free tissue is brought in to cover exposed tendon, bone or joint, since those structures die if left uncovered.
A toe is moved to the hand with its vessels, nerves and tendons to replace a missing thumb or finger, restoring grip and pinch.
Step by step, from arrival to discharge.
Tendons, nerves, vessels, bone and skin assessed individually, since a hand injury frequently damages several and the plan depends on all of them.
The therapy protocol is decided alongside the operation, because what is repaired determines which movements are permitted in the first weeks.
Repair or grafting of tendons and nerves under magnification, flap coverage where structures are exposed, and bone fixation where needed.
A splint is applied before the patient wakes, holding the hand in a position that protects the repair while preventing the ligaments shortening.
Therapy frequently begins within days, following a specific protocol of permitted movements that protects the repair while preventing adhesions.
Movement progresses from protected to active to resisted over months, with secondary procedures such as tenolysis considered once recovery plateaus.
Frequencies follow published guidance; your personal risk depends on your health and the surgeon.
The central fact about hand surgery is that the operation is the smaller half of the treatment. A technically perfect tendon repair in a hand that is not moved correctly afterwards binds down in scar and ends stiff, and a stiff hand is frequently worse than the injury that caused it. Hand therapy, several times a week for months, with a specific protocol matched to exactly what was repaired, is what converts a good operation into a working hand. Patients who cannot or do not attend get worse results than the surgery deserved.
Stiffness is therefore the enemy rather than an inconvenience. Modern hand surgery is built around allowing protected movement as early as safely possible, because the tissue planes that let tendons glide are lost within weeks of immobility. That is why splints are designed to permit some movement rather than to prevent all of it, and why the instructions about which movements to do and which to avoid are precise rather than general advice.
Nerve recovery runs on its own slow timetable and cannot be hurried. Fibres regrow at roughly a millimetre a day from the point of repair, so sensation returning to a fingertip after a repair at the wrist takes many months, and it is frequently incomplete. Older patients recover less. Cold intolerance, meaning pain and discomfort in cold weather, follows most significant hand injuries, is extremely common, frequently permanent and almost never mentioned in advance.
Timing matters more than in most reconstruction. Tendons, nerves and joints all do better repaired early than late: a nerve repaired within weeks recovers better than the same nerve grafted a year later, and a joint stiff for months rarely regains full movement. That is one reason acute hand injuries are treated where they happen, and why late reconstruction is harder and less predictable than getting it right the first time.
The dominant complication in hand surgery. Scar tissue binds tendons and joints, and a hand immobilised too long or not exercised properly becomes stiff regardless of how well the repair was done.
Nerve fibres regrow at roughly a millimetre a day and recovery is frequently partial, with altered rather than normal sensation, especially in older patients.
Pain and discomfort in cold weather after hand injury and nerve repair, which is extremely common, poorly recognised and frequently permanent.
Persistent nerve pain or complex regional pain syndrome, which can dominate the outcome regardless of how well the structures were repaired.
Weakness or numbness where a tendon, nerve graft or flap was taken, and altered gait or footwear difficulty after toe transfer.
A repaired tendon pulling apart in the first weeks, usually from using the hand against instruction, which means returning to theatre.
Infection in the hand spreads quickly along tendon sheaths and is treated urgently, because delay costs function rather than just time.
Hand therapy is not aftercare in the ordinary sense; it is half the treatment. It frequently begins within days of surgery, runs several times a week for months, and follows a specific protocol matched to exactly what was repaired. A patient who attends gets a working hand; a patient who does not gets a stiff one, and no surgical technique compensates for the difference. Arranging therapy before the operation, and confirming it can be delivered where you live, is the single most important preparation.
Elevation and swelling control dominate the first days. A swollen hand stiffens quickly, so the hand is kept above heart level, and the splint holds the joints in a position that prevents the ligaments shortening. The specific position matters, which is why a hand splint is made rather than bought.
The instructions about movement are precise rather than general. After a tendon repair, some movements are actively encouraged from the first week while others will rupture the repair, and the difference is not intuitive. Following the protocol exactly, rather than doing more because the hand feels capable of it, is what protects the repair while preventing stiffness.
Recovery is long and stepwise. Grip strength builds over months, sensation advances slowly as nerve fibres regrow, and cold intolerance frequently persists for years. Secondary procedures to release tendon adhesions or improve nerve recovery are considered only once progress has plateaued, usually after a year. Judging the result before then underestimates what therapy will still achieve.
Days 1-5
The hand is splinted in a protective position and elevated to control swelling. Hand therapy frequently begins within days rather than weeks.
Days 6-21
A specific protocol of permitted movements begins, matched to what was repaired. Splints are adjusted. Flying is not usually cleared before 2 weeks.
Weeks 4-12
Therapy several times a week, progressing from protected to active to resisted movement. This period determines how much function returns.
Months 3-6
Grip strength builds. Nerve recovery advances slowly down the hand. Return to manual work is considered from around 3 months.
Months 12-24
Sensation reaches its final state. Secondary procedures such as tenolysis or further nerve work are considered once recovery has plateaued.
Coverage and structural repair are achieved reliably. Exposed tendon, bone and joint can be covered, and divided tendons and nerves can be repaired or grafted.
Function returns partially in most cases and fully in few. The honest measure is function against the injury rather than against the other hand, and patients told that are far more satisfied.
Sensation takes many months to return as nerve fibres regrow, is frequently altered rather than normal, and recovers better in children than in older adults.
Cold intolerance is very common, frequently permanent, and improves somewhat over 2 years. It is the single most under-warned consequence of hand injury.
Hand reconstruction is usually funded as treatment of injury or disease, and importantly funded together with the hand therapy that determines the outcome. That combination is its main advantage over private treatment, because an operation without therapy is half a treatment and therapy is the half that decides how the hand works.
Where it is paid for privately, the prices on this site come from verified clinic records for each named procedure. The range is wide, from a tendon repair to a toe-to-hand transfer with microsurgery and a foot donor site.
The cost that is almost never quoted is therapy, which runs several times a week for months. For anyone considering surgery abroad, that therapy happens at home, has to be arranged and paid for separately, and without it the operation is unlikely to deliver what it promised.
Why quotes for the same procedure differ, so you can compare packages fairly.
Options to weigh before deciding, surgical and non-surgical.
Intensive hand therapy frequently achieves more than patients expect, and is worth maximising before adding another operation.
Where a hand works adequately for daily life, further surgery adds risk of stiffness and may not add capability.
Partial hand prostheses and adaptive equipment sometimes restore specific tasks more reliably than reconstruction of a badly damaged hand.
A stiff, painful, insensate finger can impede the rest of the hand, and removing it occasionally improves overall function.
Where the limiting problem is scar rather than damaged tendons or nerves, a smaller operation may restore most of what is missing.
Ask the same questions at every consultation so you can compare answers.
Because a technically perfect repair in a hand that is not moved correctly binds down in scar and ends stiff, and a stiff hand is frequently worse than the injury that caused it. Therapy converts an operation into function.
It typically runs several times a week for months, following a protocol matched to exactly what was repaired. The difference between patients who attend and those who do not is larger than the difference between surgical techniques.
Nerve fibres regrow at roughly a millimetre a day from the point of repair, so sensation returning to a fingertip after a repair at the wrist takes many months. Recovery is frequently incomplete.
Age matters considerably, with children recovering far better than older adults. Sensation that returns is often altered rather than normal, and that is the usual outcome rather than a complication.
Pain, aching and discomfort in the hand in cold weather, which follows most significant hand injuries and nerve repairs. It is extremely common, frequently permanent and almost never mentioned in advance.
It usually improves somewhat over 2 years and rarely disappears. Gloves and keeping the hand warm help. Knowing it is an expected consequence rather than a sign of a problem makes it easier to live with.
Sometimes, if the part is preserved correctly and the patient reaches a replantation unit quickly. The part should be wrapped in damp gauze, sealed in a bag, and placed on ice rather than directly in contact with it.
Whether to replant depends on the finger, the level, the patient’s job and the quality of the cut. A stiff insensate replanted finger can be worse than a well-healed amputation, so it is a judgement rather than an automatic yes.
A toe is moved to the hand with its vessels, nerves and tendons to replace a missing thumb or finger. It restores pinch, which is most of what a thumb does, and it is a living, sensate digit that grows in children.
The trade is major surgery, a foot donor site, and a digit that clearly looks like a toe. For thumb loss it is frequently the best functional option available.
Because tendons, nerves and joints all do better repaired early. A nerve repaired within weeks recovers better than the same nerve grafted a year later, and a joint stiff for months rarely regains full movement.
That is why acute hand injuries are treated where they happen rather than travelled for, and why late reconstruction is harder, less predictable and often limited by what has already stiffened.
Partially in most cases and fully in few. Hand reconstruction restores cover and structure reliably, and movement and sensation only in proportion to what was damaged and how well therapy goes.
The honest measure is function against the injury rather than against the other hand. Patients told that clearly at the outset are far more satisfied than those expecting restoration to normal.
Desk work at around 2 to 6 weeks depending on the hand and the repair, manual work frequently at 3 months or later. Anything involving gripping, lifting or vibration waits longest.
Tell the surgeon exactly what your job involves. A repair that allows typing at 3 weeks may not allow using tools for 3 months, and planning for that matters for income as much as for healing.
A secondary operation to release scar adhesions that have bound a repaired tendon so it cannot glide. It is considered once recovery has plateaued, usually a year or more after the original repair.
It is followed immediately by intensive therapy, because the adhesions reform quickly if the tendon is not moved. It is a recognised part of hand reconstruction rather than a sign the first operation failed.
Usually, as treatment of injury or disease rather than cosmetic surgery, and importantly it is usually funded together with the hand therapy that determines the outcome.
That combination is its main advantage over arranging surgery privately. An operation without therapy is half a treatment, and therapy is the half that decides how the hand works.
Hand reconstruction is among the poorest fits for travel on this site. Therapy several times a week for months determines the result, and it cannot be delivered from another country.
Acute injuries are treated where they happen for the same reason plus timing. If you are considering travel for a late reconstruction, arrange and confirm local therapy first, because without it the operation is unlikely to help.
A hand surgeon working with hand therapists as part of the same service, rather than a general plastic surgeon operating without therapy attached.
Ask how soon therapy starts, how often, and who provides it. Ask their annual volume in your specific problem. A unit that answers the therapy questions first understands what determines the outcome.
An operation in which a toe, usually the second or the great toe, is moved to the hand with its artery, vein, nerves and tendons, and reconnected under a microscope to replace a missing thumb.
It restores grip in a way no prosthesis matches, because the transferred digit has sensation. The foot is functional afterwards, though the gap is visible and some people find balance takes weeks to adjust.
Hand therapy largely determines the outcome of hand reconstruction. A technically excellent tendon repair that is not moved on the right schedule ends up stuck in scar, while an average repair with good therapy can work well.
Sessions start within days and run two or three times a week for months. This is the reason hand reconstruction travels worse than almost any other procedure in plastic surgery.
Sometimes, by releasing the joint capsule or freeing tendons from scar, but results are modest compared with preventing the stiffness in the first place. The operation only works if therapy follows immediately.
Surgeons generally want to see that a patient has plateaued despite good therapy before operating, and that they can commit to the therapy afterwards. Without that, releasing a joint simply lets it stiffen again.
A thickening of the tissue under the palm that pulls fingers into the palm over years, most often the ring and little fingers. It is not related to injury and runs in families.
It is treated by needle release, injection or open surgery, each with different recurrence rates and recovery. It is a different problem from post-traumatic contracture, though the finger position can look similar.
Sensation after nerve repair improves for 2 years and rarely returns to normal. Most people regain protective sensation, meaning they can feel heat and pressure, and lose fine discrimination.
Cold intolerance is common and underdiscussed: many people with a repaired hand find cold weather genuinely painful for years. It is worth asking about before surgery rather than discovering afterwards.
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