History of Hand Surgery

Hand surgery is one of the last disciplines to emerge as its own specialty. This specialty was founded through the combined efforts of general surgeons, plastic surgeons, orthopedic surgeons, vascular surgeons and neurosurgeons and was thought to find its beginnings in the casualties of World War II. With an unmatched number of survivors with hand injuries, there was a growing need for advancement in the care of acute injuries that predictably lead to late hand deformities. As a result, there has been a push for a greater understanding in the treatment of hand disorders.

In the early days of the war, patients were randomly assigned to plastic, orthopedic, neurosurgical or general surgical units. Over time, however, it became increasingly evident that a multidisciplinary approach was necessary in the care of the injured hand. Therefore, a ward designated specifically for hand surgery was created and led by a plastic surgeon, J. William Littler. Based on this model, numerous other referral centers for the care of the hand were established throughout the country. Furthermore, because of the fact that plastic surgeons have expertise in wound coverage and trauma reconstruction, regional hand centers were then set up in hospitals known for plastic surgery.

There are a great number of surgeons who have contributed to the development of this field, however it would be impossible to mention all of them here; only a few of the outstanding achievements will be highlighted. Dr. Alan Kanavel was a general surgeon in Chicago who gained a great experience in infections of the hand. He published a landmark text on this subject in 1932. Dr. Sterling Bunnell was another general surgeon who was known for the emphasizing the importance of gentle handling of tissues, the use of the tourniquet, nerve grafts, pollicization of the index finger, among numerous other things. There are many orthopedic surgeons who have furthered the development of hand surgery. Dr. Harold Kleinert advanced our current knowledge of tendon repair and healing as well as contributing to knowledge in the revascularization of the upper extremity. Drs. Dieter Buck-Gramcko, Adrian Flatt and Joseph Upton are three orthopedic surgeons who have imparted invaluable experience in the care of children with congenital hand deformities.

Dr. Sumner Koch was a plastic surgeon that made advances in skin coverage, the treatment of tendon and nerve injuries as well as in the treatment of Dupuytren's disease. He was made president of the American Society for Surgery of the Hand in 1950. Sir Harold Gillies, another plastic surgeon, made great strides in our understanding of skin flap surgery. More recently, plastic surgeons have advanced the field of microsurgery. Neurovascular anastomoses are performed for thumb reconstruction as well as for digital replantation. As plastic surgeons, we can now transfer whole muscles from other areas of the body to restore function in the upper extremity. Improvements in our understanding of nerve injury and regeneration, along with refinement in microsurgical techniques has allowed us to perform procedures on peripheral nerves that relieve nerve compression or to repair injured nerves following traumatic events. The experience with nerve injuries and paralysis has naturally led to refinements in tendon transfers to improve function in the hand and upper extremity. Better understanding of muscle physiology, nerve repair and biomechanics has enable hand surgeons to restore function to the injured hand.

Though the World War II era was the impetus behind much of the development of hand surgery, experience, knowledge, research and further technological advances has continued to flourish even beyond that time. This is owed to a combined effort of multiple disciplines. With further specialization of this unique field we expect to make great strides in the future.

Surgical Missions

Hand Help is an annual medical mission to provide free hand surgeries to the underprivileged of Honduras, repairing injuries and deformities of the upper limb from shoulder to fingers. Dr. J. Grant Thomson has led a team of plastic, orthopedic, and hand surgeons as well as anesthesiologists and operating room staff since 2000. Please visit our website at http://handhelp.org for more information about us and about ways to support us.