The mechanics of hand reconstruction

Upon arriving at Mass General, David met with his care team led by Kyle Eberlin, MD, hand reconstruction surgeon in the Division of Plastic Surgery who serves as the associate director of the Hand Surgery Fellowship at Mass General and whose practice focuses on complex hand reconstruction surgery, peripheral nerve surgery and microsurgery. His team also included Neal C. Chen, MD, interim chief of the Orthopaedic Hand Surgery Service, director of the Hand Surgery Fellowship at Mass General and whose practice focuses on complex hand reconstruction surgery, peripheral nerve surgery and microsurgery.

“After the accident,” Dr. Eberlin explained, “David developed a severe infection on the back of his hand which required extensive surgery in Bermuda to clear the infection. This unfortunately left him missing a large piece of skin on the back of his hand with exposed tendons. The human body tries to heal and close a wound like this on its own, but it’s extremely challenging in this location and when the wound is large. There’s a loss of mobility, risk of continued infection, and, if the exposed tendons die, it is a problem that threatens the entire arm.”

“When my doctors first told me how serious the injury was, I broke down and cried. If the infection had spread further, they might have needed to amputate my hand,” David said. As someone who loves tai chi and makes a living as a sign maker, he confessed, “it would’ve really hurt my feelings to lose my hand.”
Together, David, Dr. Eberlin, Dr. Chen and the rest of the care team discussed the details of the hand reconstruction surgery and expected outcome, and David felt comfortable proceeding. “Dr. Eberlin was outstandingly friendly,” David continued. “I felt I could talk to him about everything.”

With the decision made to proceed with hand reconstruction surgery, Dr. Eberlin and Dr. Chen set out to give David the chance for a functioning and pain-free hand. During the approximately six-hour procedure, the two Mass General doctors and their teams removed scar tissue from David’s hand, freed up and repaired the damaged tendons, and then performed a free flap tissue transfer from David’s thigh to provide skin coverage where it was missing on his hand.
Dr. Eberlin explained, “The back of the hand doesn’t have enough excess tissue and skin to close a wound this large. That’s why we did the free flap (skin transplant) from David’s thigh, where most people have sufficient excess. A free flap is a tissue transplantation from one part of the body to another. It contains an artery and vein which – when connected – provide a new blood supply to the tissues.” Dr. Eberlin added that Mass General has a 98-99 percent success rate with this special type of free flap tissue transfer.

David noted, “I’d never had a big surgery like this, but I embraced that this was something that had to happen. I made up my mind to be happy the whole time I was at Mass General. One of the nurses said I didn’t seem worried about anything. I said, ‘Years of tai chi give you a certain mentality!’ It was a good experience.”

Dr. Eberlin proudly notes that what makes Mass General’s patient care in this area so unique and positive is the collaborative energy between the Orthopaedics, Orthopaedic Hand Surgery and Plastic Surgery teams, as well as the expertise to handle challenging and unusual cases.

The path to recovery

After David’s successful hand reconstruction surgery, Dr. Chen and Dr. Eberlin guided David through his multi-month recovery treatment plan. This included a week of monitoring at Mass General to ensure the hand and flap were healing properly and that David’s circulation was functioning normally, as well as rehabilitation with Occupational Therapy (OT) during his inpatient and outpatient care to begin the vital process of regaining use of his hand. The therapists made him a customized splint, challenged him with exercises, and worked on his ability to hold everyday items like a toothbrush. Occupational therapy has helped David to continue his Tai Chi practice as well as his job.
Dr. Eberlin remarked, “From the day I met David, his positive attitude was apparent. It is a pleasure to care for patients who are so motivated to do well, and it definitely impacts their recovery.”

Dr. Chen agreed, “David’s willingness to get better and his own efforts to rehab his hand were remarkable. As doctors, nurses and OTs, we gave him the door to walk through, but he’s done the work.”

More than a year has passed since the injury and David has returned to work. David is pleased with the results of his surgery and recovery, noting that people compliment his recovery and the quality of the graft. “I don’t quite have a full range of motion back yet, but it’s improved a lot. I had great results.”
As an international patient at Mass General, David’s entire care journey was coordinated by Mass General Brigham International Patient Services team, whose staff is dedicated to helping international patients navigate Mass General, through assistance with making appointments, medical records requests, concierge services, language interpretation and any other needs a Bermudian and international patient might have before, during and after their Mass General visit.

“Keep up the good work, Mass General,” David concluded.