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I thought only orthopedic surgeons perform hand surgery, but Dr. Kargel is a plastic surgeon. How is she able to practice hand surgery?
Orthopedic and plastic surgeons are both trained to perform basic hand surgeries. For those of us who really love hand surgery, there is an additional year-long fellowship that focuses solely on surgeries involving the upper extremity. Dr. Kargel completed a six year plastic surgery residency, then completed an additional year of hand and microsurgery fellowship. She is board-certified in plastic surgery and also has board certification in hand surgery (now called subspecialty certificate in surgery of the hand).
How long can I wait after an injury that involves a broken bone, an injured nerve, or a cut tendon to be seen in clinic?
With these types of trauma, the best window for operative treatment (if indicated) is within two weeks of the injury. So, the sooner you can come in, the better. Sometimes, it can mean the difference between having a broken bone reset in the clinic and having to go to the operating room to treat it.
Where can my child have surgery?
Most hand surgeries are outpatient procedures, meaning the patient has surgery and goes home that same day. We operate at the Children’s ambulatory Dallas campus on Tuesdays and at the Children’s Plano campus on Thursdays and Friday.
What should I make sure my child does following surgery?
The afternoon and evening following their surgery, you can begin giving them the prescribed pain medication. Although we make sure there is enough pain medication prescribed for at least a week, most children only need it for a couple of days. Ibuprofen (ie Motrin) can be started the day after surgery and acetaminophen (ie Tylenol) can be taken instead of the prescribed narcotic. Just remember to avoid taking acetaminophen and the narcotic at the same time, since they both contain acetaminophen. If a splint was placed at the end of surgery, keep it in place and do not remove it. When taking a shower or bath, keep it covered, clean, and dry. Keep the hand elevated above heart level as much as possible over the week following surgery to decrease swelling and throbbing. If there are any problems or concerns with bleeding, increased swelling or pain, fever, etc., you can call the office during clinic hours or go to the emergency room during off-clinic hours and on the weekend.
What recovery time can I expect for my child following surgery?
This is dependent on what type of procedure is performed. For example, fractures often require a minimum of four weeks immobilization, after which pins are removed, while tendon repairs require immobilization for three to four weeks and then therapy to gradually increase range of motion and strengthening. Thumb duplication reconstruction and opponensplasty (tendon transfer to allow thumb to bend towards the little finger) are casted for three to four weeks after surgery, while polydactyly excision for extra digits next to the little finger and trigger thumb releases are usually only covered with a soft dressing for one week.
Will my child have to have therapy to make the fingers move again after surgery?
Sometimes fingers can become stiff after having surgery or being immobilized in a splint or cast. During your child’s clinic visit, it will be determined whether or not he or she requires additional therapy. Our hand therapists are in clinic with us, and they are available to see our patients if needed. They can make custom-fit splints and teach range of motion and strengthening exercises, among other things, during this time.
I had a cast put on while in clinic. What am I supposed to do to take care of it?
It is very important to keep the cast clean and dry at all times. When taking a shower, place a bag over the cast and apply tape to make sure it doesn’t leak. Sometimes, we are able to apply a waterproof cast, depending on the location and type of injury. In those cases, we will give you specific separate instructions on cast care. Do not place anything under the cast if it feels itchy—this includes hangers, pencils, coins, tissues, and toys. To treat itching, you can use a hair dryer on a cool setting and aim under the cast edges. If the cast becomes tight due to swelling in the fingers or hand, elevate the extremity above heart level for 5-10 minutes. If there is still no improvement, contact our office during weekday business hours or the emergency room if after hours or on the weekend to have a cast check. Other reasons for cast checks include rubbing of the cast, ulceration of the skin, wetness of the cast, or if fingers become increasingly numb, blue or cold.
Can my child participate in sports after his/her injury?
This depends on the type of injury and it’s location. Fractures that are easily displaced or dislocations that have required reduction are at risk for re-injury if playing sports while in a cast. If pins are placed or tendons are repaired or reconstructed, it’s important to avoid contact sports, because the repairs and pins could be damaged. Once out of the cast, we begin range of motion exercises to get your child back to full function as quickly as possible.
How are finger and hand burns treated in children?
Immediately following a burn, it is important to have appropriate wound care to prevent infection and early contracture. Once scarring develops or contractures are noted, we work closely with our hand therapists to develop a regimen of stretching, scar massage, and splinting. Sometimes surgery is required to release scars that prevent fingers from straightening or separating. In this case, we will rearrange tissue to break up the line of scar or place a small skin graft to fill a defect.
My baby was born with extra fingers. What can be done for this?
Extra fingers next to the pinkie often have thin skin bridges and can be treated in the clinic with clip application. These are usually seen in multiple family numbers and easily treatment. Is performed between two and four weeks of age. If the bases are too wide or thick, we wait until the patient is over the age of 1 year old and plan for excision in the operating room. When the thumb is involved, reconstruction usually involved removal of the smaller duplication site and rebalancing of tendons and ligaments. This is also done after the child is over the age of 1 year old.
Why is my baby not able to straighten his thumb?
Triggering of the thumb causes inability to actively straighten (or sometimes inability to actively bend) the thumb. Thickening of the flexor tendon and relative large diameter of the tendon compared to A-1 pulley prevent smooth gliding. Early intervention involves stretching, massage, and night-time extension splinting. Over the age of 1-2 years old, persistent triggering is treated with a day surgery procedure that involves releasing the A1 pulley to allow for more space for the tendon to glide.