The Center for Hand and Microvascular Surgery deals with all surgical problems involving structures in the upper extremity, including bones, joints, muscles, tendons, nerves, blood vessels, and skin.  Our specialists are certified both in Hand and Microvascular Surgery and also in either Orthopedic Surgery or Plastic Surgery, both in Israel and abroad (either the United States or France).  They use the most advanced surgical techniques available in the world to treat fractures, nerve and tendon injuries, congenital (birth) deformities, degenerative or chronic diseases, and massive trauma.  The Center is continually active in major microvascular procedures (utilizing the operating microscope), including replantation (of amputated fingers, hands, and arms) and free tissue transfers.  Our specialists have published major articles in the leading Hand Surgery and Plastic Surgery and Orthopedic journals in the world.  We work as a team and are an integral part of the Department of Plastic and Aesthetic Surgery.

The Center’s surgeons repair fractures of the wrist (e.g., distal radius and scaphoid), hand, and fingers.  The techniques include the use of specialized metallic plates and screws and pins.  Extremely complicated fractures comprise a large portion of our work at the wrist joint, particularly those fractures that will not heal well with cast treatment alone.  Currently we perform about 200 such wrist fracture operations each year.  We also treat patients who have had fractures in the past that did not heal correctly (“malunions”) or did not heal at all (“non-unions”).  These operations usually require the use of bone graft that may be harvested from the arm or from the hip region, depending upon the amount of bone needed.  Occasionally we must use bone that has its blood vessels still attached in order to increase the chance for a successful outcome, and in such cases we take vascularized bone from one part of the body and use the operating microscope to reattach the bone’s blood vessels near the area of the unhealed fracture so that the bone will be more likely to heal.

Lacerations of nerves and tendons and arteries of the forearm, hand, and fingers demand delicate and precise repair in order to restore hand function. The operating microscope is indispensable to achieving a good result after nerve or artery repair, and all nerve and blood vessel repairs here are performed using the microscope.  Failure to restore good blood supply can result in an amputation of the hand or finger, and failure to achieve a proper nerve repair prevents recovery of motor and sensory function.  We have a large caseload of tendon repairs as well, and the rehabilitation of good hand and finger motion after repair is a combined effort of the Hand Center and the Department of Occupational (Hand) Therapy.  Specialized splints and intensive therapy with a staged protocol of exercises form the core of our rehabilitative program.

Congenital deformities are seen at birth, and they present in a variety of ways.  Examples include syndactyly (two or more fingers that failed to separate and are connected by a web of skin and soft tissues), polydactyly (extra fingers), and more complex syndromes such as Apert’s Syndrome (cranial and facial deformities combined with complex syndactyly), brachydactyly (short fingers), macrodactyly (excessively large fingers), and radial club hand (absent thumb with a major angulation at the wrist due to the absence of one of the two long bones normally found between the elbow and hand).  Our Center sees and treats these children with surgical procedures at the earliest feasible and appropriate age, usually four to six months old.  Some of the procedures include the use of skin grafts and flaps, nerve and blood vessel reconstruction, and reconstruction of a missing thumb.  Many of these children require a series of operations in order to achieve the best possible result.  Every effort is made to provide these children with the most functional and aesthetic hands and fingers possible.

In the broad category of nerve surgery, we repair cut nerves (anywhere in the upper and lower extremities), relieve the pressure in nerve compression syndromes (e.g., carpal tunnel syndrome at the wrist, cubital tunnel syndrome at the elbow), and reconstruct devastating nerve injuries using nerve grafts.  Injuries to the brachial plexus – a very complicated network of nerves in the region of the neck and shoulder that is responsible for all sensation and motion in the arm and hand – present an extraordinarily difficult problem where the operation may often last more than 10 hours.  Such injuries may occur at birth or from trauma at a later age, and they cause paralysis and loss of feeling in the arm and hand.  Dr. Carole Pidhorz of our Center has vast experience with both types of injuries, and we urge all patients (or their parents) who may be suitable for such surgery to seek consultation promptly, because the success rate drops significantly if too much time goes by before surgery.

The traumatic amputation of a thumb or multiple fingers, or of a hand or arm, is a devastating injury.  Many such amputated parts may be replanted (surgically restored to their normal positions), and the specialists at the Center for Hand and Microvascular Surgery perform about 50 such operations each year, wherein we repair the fractured bone, fix the lacerated nerves and tendons, and reconnect the arteries and veins (which may be as small as 0.4 mm in children) with the operating microscope.  When multiple fingers are involved – occasionally all fingers on each hand – the surgery may last over 20 hours.  We work together as a team in order to provide these patients with the best chance for good function.

There are many non-emergency conditions that may require surgery of the hand or fingers, including arthritis (degenerative changes of the cartilage and bone in the joints), Dupuytren’s Contracture (which can lead to fingers that are flexed and cannot extend), cerebral palsy (partial paralysis of the body at birth), tendinitis (inflammation of tendons), fingernail deformities after injury, and tumors – both benign (such ganglions and lipomas) and malignant.  Some of these conditions require excision of certain tissues, fusion of bones together (arthrodesis), or transfer of tendons from one location to another to improve functional motion.  The Center has broad experience with these and other conditions as well.

Some patients suffer a massive defect of skin, soft tissue, muscle, or bone that was lost through injury, burn, or excision of a tumor.  Reconstruction may require the transfer of tissue with its blood vessels from elsewhere in the body and reattachment of the blood vessels using the microscope in order to close large wounds that will not otherwise heal.  These are called free tissue transfers (or free flaps), because the tissue is completely disconnected from the body (it is “free” of the body) and then reconnected elsewhere to restore skin coverage, muscle function, or bony stability.  Such demanding operations are often the only possible way to restore function or prevent an amputation, and they require a team effort for a procedure that may last 10 to 20 hours.  Dr. Carole Pidhorz leads our team in all free tissue transfers, including the toe-to-thumb operation that restores a functioning thumb when one has been lost in an accident.  When removal of the great toe (or another toe) is necessary in order to build a new thumb – and the thumb is the most important finger, contributing nearly half of the useful function of the hand – the resulting loss to the foot is generally minimal.  Many of our patients have even returned to long distance running without pain or limp.

Our goal is to offer to every patient an understandable description of the injury or condition that has brought him or her to us and a full explanation of the options for treatment, whether surgical or non-surgical, along with a review of the potential risks and benefits of each treatment.  It is important to each one of us that every patient be well-informed and able to make a reasonable decision about the course of treatment most appropriate for him or her.