This covers the repair of the structures injured by a cut, a crush or a fracture: tendons, nerves, vessels, bone and the skin covering them.
The hand is the part of the body where a small injury can leave a large limitation. A two-centimetre cut in the palm can divide a flexor tendon and a digital nerve, and on that depends whether the finger bends again and has sensation. That is why a hand wound is never "just a cut": the first thing is to establish which structures are involved, and that needs an examination done in the consulting room, not by eye.
There is a factor that weighs more in the hand than almost anywhere else: time. A divided flexor tendon is repaired with a good result in the first days; after two or three weeks it retracts, and direct repair is no longer possible, so a two-stage tendon graft is needed and the result is worse. Something similar happens with nerves. Coming late — very frequent when the cut looked minor or when the skin healed well — is the main cause of avoidable lasting damage in this condition.
It usually helps when there is
- A cut on the hand or fingers with difficulty moving or bending.
- Loss of sensation in a finger after a wound.
- A fracture of the bones of the hand or fingers.
- A wound with loss of skin or with structures exposed.
- An old injury that healed badly or left a limitation.
Worth discussing first if
- A wound with significant active bleeding: an immediate emergency.
- Amputation or severe crush injury: urgent transfer with the amputated part.
- Established infection, treated before any repair.
- Being unable to complete the rehabilitation, which here is decisive.
- An injury more than three weeks old, which changes the strategy completely.
None of these rules the procedure out on its own; all of them change the conversation.
What is repaired
One wound usually involves more than one structure.
Tendons
Flexors or extensors. The repair is only half the treatment: the other half is a precise movement protocol over weeks.
Nerves
Repaired with microsurgery. Sensation comes back slowly, at around a millimetre a day, and it can take months to reach the fingertip.
Bones and cover
Fixation of fractures with material that allows early movement, and cover with a graft or flap if there is skin loss.
Repair so that movement can start early
In the hand, stiffness is the enemy. A hand immobilised for weeks goes stiff even when the repair was perfect, and recovering from that stiffness costs more than the original injury. So everything is planned to allow movement to start early: strong tendon sutures, stable fracture fixation and splints that protect without blocking.
The initial examination defines the rest. The movement of each tendon, sensation on both sides of the finger and the blood supply are checked finger by finger, because a small wound can hide several injuries. What is not identified at the start is discovered late, when it no longer repairs as well.
Rehabilitation with a hand therapist is part of the treatment, not optional. In flexor tendon repairs the movement protocol is what decides the final result, and without it the repair sticks down and the finger does not bend. When a patient is not going to be able to keep it up, it is discussed before operating.
What the process is like
Rehabilitation takes up more time than everything else.
Urgent assessment
Examination of movement, sensation and blood supply in each finger, with an X-ray if a fracture is suspected. It establishes what is injured.
Surgery
As a day case under a regional block of the arm. Repair of the structures involved and cover if needed, aiming for stability so movement can start early.
Splint and reviews
A protective splint in a specific position, and dressings. Frequent reviews during the first weeks.
Rehabilitation
With a hand therapist, following a protocol defined by the structure repaired. It lasts six to twelve weeks and it determines the result.
Week by week
The timings of a tendon repair, which is the most demanding.
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Weeks 1 to 3
Splint at all times and protected movement following the protocol. Hand elevated to reduce swelling. No force and no gripping.
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Weeks 4 to 6
Progressive active movement. The splint is withdrawn gradually. The swelling settles and the range of movement improves.
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Weeks 7 to 12
Strength and grip work begins. Back to work according to its physical demands. If there was a nerve injury, sensation starts to advance.
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Months 6 to 12
Consolidated result. Recovery of sensation can continue up to a year or more.
Risks, and what is not promised
Those specific to the hand: joint stiffness, adhesions of the repaired tendon limiting its glide — the most frequent complication and the reason for the rehabilitation — rupture of the tendon repair in the first weeks, incomplete recovery of sensation, neuropathic pain and malunion of a fracture. To that are added infection, loss of the skin cover and, infrequently, complex regional pain syndrome.
The time elapsed since the injury determines the outlook more than the technique does: a late tendon or nerve repair gives worse results for biological reasons, not through any lack of surgical skill.
A hand identical to the one before is not promised: after a significant injury some limitation of movement, strength or sensation usually remains. What is sought is a hand that works for life and for work. These risks are reduced by early repair, fixation that allows early movement and completed rehabilitation. They are not eliminated. The ones that apply to your case are set down in writing in the informed consent.
The information on this page is for guidance and does not replace an in-person medical consultation. Medical practice is an obligation of means, not of result.
The questions we are asked most about hand injuries
Less than it seems. A divided flexor tendon repairs well in the first days; after two or three weeks it retracts and can no longer be joined directly, which forces a two-stage graft with a worse result.
Something similar happens with nerves. If after a cut you cannot bend a finger or you have lost sensation, the consultation is that week, not when the wound closes.
Yes, but the strategy changes: it is no longer a direct repair but a reconstruction, often with a tendon graft and in two stages.
The result is usually less than that of an early repair, and even so useful function is recovered in many cases. It is worth coming in.
Because a repaired tendon sticks to the neighbouring tissues if it is not moved, and then the finger does not bend even though the suture is perfect. Protected movement prevents that sticking.
In the hand, surgery is half the treatment. The other half is six to twelve weeks of therapy, and without them the result is lost.
When a nerve is repaired, sensation comes back slowly: the nerve grows at around a millimetre a day, so reaching the fingertip can take several months.
Recovery is usually partial and better in younger people. There may be temporary tingling or hypersensitivity during that process.
Question not answered here? There are more answers in the frequently asked questions.
