Tumors, Soft Tissue Reconstruction, & Peripheral Neurosurgery

Peripheral nerves, ligaments, tendons, muscle, fat, and skin are considered “soft tissues,” and their repair and reconstruction can prove extremely challenging, sometimes requiring specialized techniques such as microsurgery, endoscopy, and arthroscopy. During the 1980s and 1990s, the field of plastic surgery was largely devoted to the development of special techniques to reconstruct these tissues, including the use of tissue flaps, tissue grafts, and microsurgery.

Specialized soft tissue procedures, such as flaps and nerve reconstructions, require not only special surgical procedures and techniques but special physical dexterity and training. For example, when performing microsurgery, plastic surgeons use sutures that are roughly one-third to one-half the diameter of a human hair. Working at such small scale under the microscope, unless specially trained, even normal breathing can affect the placement of a simple stitch!

Dr. Chin specializes in various reconstructive conditions of the upper extremity, including:

• Carpal tunnel syndrome

• Cubital tunnel syndrome

• Nerve entrapments

• Nerve injuries

• Repetitive stress injuries

• Low-energy cumulative trauma

• Tendon injuries

• Ligament injuries and sprains

• Arthritis

The peripheral nervous system

Most people know that the central nervous system refers to the nerves that run through the brain and spinal cord. However, far fewer people have heard of the peripheral nervous system, which is the name given to the system of nerves that extend outside of your brain and spinal cord and instead branch out to the ‘peripheral’ parts of your body.

What do nerves do?

The purpose of nerves is to transmit impulses throughout the body to give feeling and help create movement. This is why nerve damage often leads to loss of sensation in the skin where the nerves are, and an inability to move the muscles in that area normally.

There are two main types of nerve:

• Motor nerves: these carry electrical impulses to muscles to cause them to contract and move.

• Sensory nerves: Unsurprisingly, these carry electrical impulses to the brain which transmit information from the sensory receptors about sensations such as pain, temperature, and pressure.

What happens when nerves in my hand become damaged?

When the nerves in your hand are damaged, they stop or become inconsistent in transmitting motor and sensory messages to your brain. This can cause you to lose movement, coordination, and sensation in your hands.

Can nerves be repaired?

We rely heavily on our hands, and so when an injury does occur to the peripheral nerve, repairing the damage is usually a high priority in order to regain full mobility and sensation.

To repair nerves your surgeon will need to sew together the outer layers so that the fibers and sheaths match up. After a period of between three and four weeks, the fibers of the nerves begin to regrow across the repair site. However, few people achieve a complete recovery and the regrowth process is extremely complex and the nerves do not always connect in the correct way.

What is a soft tissue injury?

Although hands may appear to be largely made of bone, any accidents that do not involve the bones or joints are usually referred to as soft tissue injuries. This can include the skin, muscles, ligaments, tendons, nerves and more.

Because soft tissue injuries are not always immediately visible, it can be difficult to diagnose them. However, there are some symptoms of soft tissue damage to look out for, including swelling, redness, bruising, stiffness, pain and loss of control or function.

Types of soft tissue injury

Soft tissue injuries tend to be classified in two ways. If during the injury the skin has been broken, it is referred to as an ‘open injury’. However, if the skin is intact then your surgeon will probably refer to it as a ‘closed injury’.

Damage most often occurs to the tendons and ligaments in the hand, and these can regularly be seen in conjunction with fractures to the bone. Prompt surgical intervention is required to achieve the best result from any repair.

Soft tissue repair

Your soft tissue repair will largely depend on the extent and location of the damage to your hand. Surgery is often performed on an outpatient basis, and rehabilitation is normally compulsory to achieve the best result from your surgery and regain full control, mobility, and strength in your affected hand.

Am I a suitable candidate for peripheral nerve or soft tissue surgery?

In order to assess your candidacy for any treatment, it will be necessary for you to attend a consultation appointment with an orthopedic surgeon. We understand that every patient is unique and therefore there are no assumptions made about any medical situation or treatment choices. During your consultation, your surgeon will take your medical history as well as conducting a thorough examination of your hand and wrist. You may also be given x-rays or CT scans of the affected area in order for your surgeon to determine the cause of your problem. Using this information, your surgeon will be able to explain your treatment options and help you to decide the right solution for your individual needs.

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