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Hand surgery is a broad term that covers many different types of procedures. Plastic surgeons who perform hand surgery seek to restore hand and finger function. But hand surgeons also try to make the hand look as normal as possible, as well. Hand reconstructive surgery may be done for many reasons, including:

Skin grafts for the hand involve replacing or attaching skin to a part of the hand that has missing skin. This surgery is most often done for fingertip amputations or injuries. Skin grafts are done by taking a piece of healthy skin from another area of the body, called the donor site, and attaching it to the injured area.

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This may be used when there is a bone fracture, or broken bone, in part of the hand, including the fingers. This type of surgery realigns the broken bone and then holds it in place, or immobilizes it, while it heals. Immobilization can be done with internal fixtures, such as with wires, rods, splints, and casts.

Tendons are the fibers that join muscle to bone. Tendon repair in the hand is a difficult surgery because of the structure of the tendon. Tendon injuries can occur due to infection, trauma, or sudden rupture. There are 3 types of tendon repair: primary, delayed primary, or secondary.

An injury can damage the nerves in the hand. This can cause a loss of hand function and a loss of feeling in the hand. Some nerve injuries may heal on their own. Others may require surgery. Generally, surgery is done about 3 to 6 weeks after the injury. This is the best time for nerve repairs that are linked with other more complicated injuries.

This procedure is done to help treat compartment syndrome. This painful condition occurs when there is swelling and increased pressure in a small space, or compartment, in the body. Often this is caused by an injury. This pressure can interfere with blood flow to the body tissues and destroy function. In the hand, a compartment syndrome may cause severe and increasing pain and muscle weakness. Over time, it can cause a change in color of the fingers or nailbeds.

For a fasciotomy, your doctor will make a cut or incision in your hand or arm. This decreases the pressure, lets the muscle tissue swell, and restores blood flow. Any tissue inside the area that is already damaged may be removed at this time. This procedure helps prevent any further damage and decrease in function of the affected hand.

Hand infections are very common. Treatment for hand infections may include rest, using heat, elevation, antibiotics, and surgery. If there is a sore or abscess in the hand, surgical drainage may help remove any pus. If the infection or wound is severe, debridement may be used to clean dead and contaminated tissue from the wound. This prevents further infection and helps promote healing.

This type of surgery, also called arthroplasty, is used in cases of severe hand arthritis. It involves replacing a joint that has been destroyed by arthritis with an artificial joint. This artificial joint may be made of metal, plastic, silicone rubber, or your own body tissue, such as a tendon.

This type of surgery reattaches a body part, such as a finger, hand, or toe, which has been completely cut or severed from the body. The goal is to restore as much function as possible. Replantation uses microsurgery. This is a complex type of surgery that uses tiny tools and is done under magnification using a microscope. In some severe cases, more than 1 surgery may be needed.

Arthritis can take a heavy toll on hands, causing pain, deformity and disability. Yet surgery to repair the damage from hand arthritis is relatively rare. One reason is that finger surgery has a high complication and failure rate. It can also sacrifice mobility for pain relief. The two main surgical options for hand arthritis are fusion (arthrodesis) and total knuckle replacement (arthroplasty).

Whether arthrodesis or arthroplasty is used depends on the joint needing repair and on the patient's age, activity level and the amount of stiffness the patient can tolerate. It's not uncommon to have both procedures performed on different joints in the same hand.

From 1962 to 1971, the U.S. Air Force sprayed nearly 19 million gallons of herbicides in Vietnam, of which at least 11 million gallons was Agent Orange, in a military project called Operation Ranch Hand. An additional quantity (1.6 million gallons has been documented) of herbicides was applied to base perimeters, roadways, and communication lines by helicopter and surface sprayings from riverboats, trucks, or backpacks. Herbicide operations in Vietnam had two primary military objectives: (1) defoliation of trees and plants to improve observation, and (2) destruction of enemy crops.

According to estimates of the Department of Veterans Affairs (DVA), approximately 8.3 million veterans of the Vietnam era (August 4, 1964, to May 7, 1975) were represented among the adult civilian U.S. population (U.S. VA, 1985). Approximately one-third, or some 2.7 million, of the Vietnam era veterans served in the Vietnam theater (defined as service in Laos, Cambodia, Vietnam, or the surrounding waters). The DVA adjusts its veteran population estimates based on the U.S. decennial census; estimates of Vietnam era service are based upon receipt of the Vietnam Service Medal, as identified on individual military discharge forms. Qualification for a service medal is limited to military units that supported operations within Vietnam and to those individuals that served in the Vietnam theater between July 1965 and April 1974 (Fischer et al., 1980). Therefore, the DVA estimate of the number who served in the Vietnam theater is restricted, based on use of the Vietnam Service Medal as an indicator of service.

Various demographic data on veteran populations, in addition to employment and disability statistics, are reported by the Bureau of Labor Statistics (BLS). These data, tabulated from the Current Population Survey (U.S. Department of Labor, 1992a,b), suggest that of the 7.9 million male veterans of the Vietnam era (August 1964 to May 1975), nearly one-half, or 3.7 million, reported having served in the Vietnam theater of operations (Vietnam, Laos, or Cambodia, or in the waters or air surrounding these countries). Estimates of the number of veterans who served in Vietnam per se are not available from these data.

These various estimates of the Vietnam veteran population are summarized in Table 3-2. From these data, it is estimated that one-third to one-half of Vietnam era veterans, or 2.7 million to 4.3 million persons, served in the Vietnam theater of operations, depending on the definition of the period and/or location of military service. Comparable estimates of those who served in Vietnam range from 2.6 million to 3.8 million.

Just as there was no ''typical" American soldier or typical military experience in Vietnam, there was no one combat experience (Shafer, 1990; Karnow, 1991). The combat experiences of individual soldiers varied according to assignment, geographical region of duty, and the period during which they served. In addition, most soldiers who were sent to Vietnam after the first American troops arrived in 1965 were sent as individual replacements, rather than as units (Karnow, 1991). The military found it more efficient administratively to replace losses piecemeal than to replace units and rebuild them. Unfortunately, this operational strategy minimized prospects for unit cohesion and contributed to low troop morale (Shafer, 1990).

In 1960, U.S. assistance to the Diem government in South Vietnam was limited to military advisors, economic aid, and some logistic support (Karnow, 1991). American military advisory forces in South Vietnam numbered fewer than 900 (MACV, 1972). Some leaders within the U.S. government and military warned that the time to act against a Communist takeover of South Vietnam had come and that further U.S. intervention was inevitable. Defoliation operations were among several supplemental actions proposed that could be conducted while decisions regarding the commitment of combat troops were pending (Buckingham, 1982). The use of herbicides in South Vietnam was recommended for several reasons: to remove foliage along thoroughfares used as cover for enemy ambushes, to defoliate vegetative areas surrounding enemy bases and communication routes, to improve visibility in heavily canopied jungle, and to destroy enemy subsistence crops (Collins, 1967; Huddle, 1969; U.S. Army, 1972). Although the first combat troops did not arrive in Vietnam until April 1965, preparations for the testing and conduct of a major aerial defoliation program proceeded in cooperation with the South Vietnamese government. In December 1961, President Kennedy authorized the use of herbicides, and on January 12, 1962, the first U.S. Air Force herbicide missions of Operation Ranch Hand were flown over South Vietnam (Warren, 1968; MACV, 1972).

The defoliation program in Vietnam began on December 4, 1961, when President Kennedy authorized the Secretary of Defense to test the military effectiveness of the defoliation of several lines of communication (MACV, 1968). Operation Ranch Hand, the tactical military project for the aerial spraying of herbicides in South Vietnam, was the first (and only) large-scale experience with chemical defoliants in U.S. military operations. According to MACV records, the first U.S. Air Force Ranch Hand missions over Vietnam were flown on January 12, 1962 (MACV, 1972); however, it was not until August 1962 that President Kennedy approved the program on a larger scale. The first major operation, to clear enemy infiltration routes, was carried out over the mangrove forests in the Ca Mau peninsula in the southernmost region of the Mekong Delta in September 1962 (Dux and Young, 1980).

Operation Ranch Hand had two primary objectives: (1) defoliation of trees and plants to improve visibility for military operations, and (2) destruction of essential enemy food supplies. Targets for defoliation by Ranch Hand included base camps and fire support bases (specifically constructed sites for storage of artillery in support of combat operations), lines of communication, enemy infiltration routes, and enemy base camps. Clearance of these areas improved aerial observation, opened roads to free travel, and hindered enemy ambush. ff782bc1db