Post Operative Complications
Miss Meg BirksConsultant Hand Surgeon
GP Education event 1st 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?