the best version of yourself




When we talk about hand trauma, we mean major injuries that have been sustained to the hand. The primary treatment of hand trauma frequently requires access to microsurgical facilities for small vessel and nerve repair.  Such facilities need to be available on a 24 hour basis. 

What surgery is available, and what techniques are used?

  • Burns and skin loss, for instance, will require surgical flaps and grafts, while the traumatic loss of digits may be treated by what is known as toe to hand surgery. 
  • Toe-to-hand surgery involves the microsurgical transfer of digits from the foot to the hand. The absence of a finger does not usually have much effect on either the function or the appearance of the hand, but when the missing digit is a thumb, or when many digits are missing, surgery may be needed.
  • Generally, the guideline in considering reconstruction is whether or not the overall function of the hand may be improved, although it is also natural and necessary to take into consideration the appearance of the hand.
  • Whichever toe is transferred, its blood vessels (artery and nerve) must be successfully joined to similar vessels in the hand for it to survive.

Tendons (to allow movement where required), nerves (to allow feeling), and the bone must also be rejoined to suitable counterparts in the hand.


Carpal tunnel syndrome occurs when the tunnel becomes narrowed or when tissues surrounding the flexor tendons swell, putting pressure on the median nerve. These tissues are called the synovium. Normally, the synovium lubricates the tendons, making it easier to move your fingers.

Risk factors for carpal tunnel syndrome include:

  • Heredity:
    • The carpal tunnel may be smaller in some people or there may be anatomic differences that change the amount of space for the nerve—and these traits can run in families.
  • Repetitive hand use:
    • Repeating the same hand and wrist motions or activities over a prolonged period of time may aggravate the tendons in the wrist, causing swelling that puts pressure on the nerve.
  • Hand and wrist position:
    • Doing activities that involve extreme flexion or extension of the hand and wrist for a prolonged period of time can increase pressure on the nerve.
  • Pregnancy:
    • Hormonal changes during pregnancy can cause swelling.
  • Health conditions:
    • Diabetes, rheumatoid arthritis, and thyroid gland imbalance are conditions that are associated with carpal tunnel syndrome.


  • Numbness, tingling, burning, and pain—primarily in the thumb and index, middle, and ring fingers
  • Occasional shock-like sensations that radiate to the thumb and index, middle, and ring fingers
  • Pain or tingling that may travel up the forearm toward the shoulder
  • Weakness and clumsiness in the hand—this may make it difficult to perform fine movements such as buttoning your clothes
  • Dropping things—due to weakness, numbness, or a loss of proprioception (awareness of where your hand is in space)


  • Nonsurgical therapy (If the condition is diagnosed early, nonsurgical methods may help improve carpal tunnel syndrome):
    • Wrist splinting:
      • A splint that holds your wrist still while you sleep can help relieve nighttime symptoms of tingling and numbness.
      • Nighttime splinting may be a good option if you’re pregnant.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs):
    • NSAIDs, such as ibuprofen (Advil, Motrin IB, others), may help relieve pain from carpal tunnel syndrome in the short term.

Surgical Treatment: 

  • Endoscopic surgery:
    • A telescope-like device with a tiny camera attached to it (endoscope) is used to see inside your carpal tunnel.
    • The surgeon then cuts the ligament through one or two small incisions in your hand or wrist.
    • Endoscopic surgery may result in less pain than does open surgery in the first few days or weeks after surgery.
  • Open surgery:
    • The surgeon makes an incision in the palm of your hand over the carpal tunnel and cuts through the ligament to free the nerve.

Dupuytren’s contracture is a hand deformity that usually develops over years. The condition affects a layer of tissue that lies under the skin of your palm. Knots of tissue form under the skin — eventually creating a thick cord that can pull one or more fingers into a bent position.


  • Dupuytren’s contracture typically progresses slowly, over years.
  • The condition usually begins as a thickening of the skin on the palm of your hand.
  • As it progresses, the skin on your palm might appear puckered or dimpled. A firm lump of tissue can form on your palm, this lump might be sensitive to the touch but usually isn’t painful.
  • In later stages of Dupuytren’s contracture, cords of tissue form under the skin on your palm and can extend up to your fingers. As these cords tighten, your fingers might be pulled toward your palm, sometimes severely.
  • The two fingers farthest from the thumb are most commonly affected, though the middle finger also can be involved. Only rarely are the thumb and index finger affected. Dupuytren’s contracture can occur in both hands, though one hand is usually affected more severely.


Treatment involves removing or breaking apart the cords that are pulling your fingers toward your palm. This can be done in several ways: 

  • Needling:
    • This technique uses a needle, inserted through your skin, to puncture and break the cord of tissue that’s contracting a finger.
    • The main advantages of the needling technique are that there is no incision, it can be done on several fingers at the same time, and usually, very little physical therapy is needed afterwards.
  • Enzyme injections:
    • Injecting a type of enzyme into the taut cord in your palm can soften and weaken it — allowing your doctor to later manipulate your hand in an attempt to break the cord and straighten your fingers. 
  • Surgery:
    • Surgically remove the tissue in your palm affected by the disease.
    • The main advantage of surgery is that it results in a more complete and longer-lasting release than that provided by the needle or enzyme methods.
  • In some severe cases, especially if surgery has failed to correct the problem, surgeons remove all the tissue likely to be affected by Dupuytren’s contracture, including the attached skin. In these cases, a skin graft is needed to cover the open wound. This surgery is the most invasive option and has the longest recovery time. People usually require months of intensive physical therapy afterwards.

More Procedures



Body Contouring



Dermal Surgery


Patient Instruction Information

What you need to know before THE operation


The pre-operative instructions are important in giving you insight on things that hamper your healing progress. Please read carefully. If you still have questions after reading this, call the rooms (011 485 4434), to have all your concerns addressed



• Do not take any aspirin-containing products (see the attached list), anti-inflammatories (e.g. ibuprofen, advil, Meloxicam), blood thinners (e.g. coumadin, warfarin, clexane), or vitamin E for 14 days before your operation. These medications thin the blood and increase the risk of bleeding. Paracetamol can be taken safely.

• Stop taking any supplements, herbal, natural, diet, or alternative drugs 14 days before your surgery (e.g. ginkgo biloba, ginseng, St. John’s wort).

• We recommend stopping birth control pills or estrogen replacement therapy 4-6 weeks before surgery, particularly for abdominoplasty (tummy tuck) or liposuction. These drugs increase the risk of blood clots in the leg.

• Only essential medications may be taken throughout the peri-operation. It’s important to inform the surgeon and the anesthesiologist are aware of any medications you take.

• Patients with heart disease, Diabetes Mellitus, Previous cerebrovascular accidents, and pacemakers should also highlight this to the surgeon and anesthesiologist.

 • Please notify our office before your surgery if you develop a cold or infection.


• Smoking should be stopped at least 2 weeks before your operation, and you should refrain from smoking at least 2 weeks after the operation as well. Smoking greatly increases the risk of poor wound healing and even skin loss.


• Arrange transport to fetch you after discharge and a person to look after you post-discharge.  

• You can take only essential medications (for example, cardiac or blood pressure pills) on the morning of surgery with a small sip of water (except those mentioned below).   

• Nothing to eat or drink after midnight the night before, and the morning of surgery. If you do eat or drink, your surgery will likely be cancelled.

• Remove all make-up and nail polish the night before surgery.

• If you are having a facelift or browlift surgery, wash your face with soap and shampoo your hair the night before surgery.

• If you are having breast surgery, make sure you have a post-operative or sports bra available and bring it into the operating room.

• Remove all jewellery and leave money and all valuables at home

• Do not shave 3 days before surgery. Shower before surgery.

• Wear comfortable, loose-fitting clothing that is easy to put on and take off (e.g. sweat pants, button or zipper shirt).

• Arrive at the hospital at least 2 hours before the scheduled operation time      

• Be prepared to take time off work. In general, at least 5-7 days (this varies quite a bit, depending on the procedure). Try to avoid strenuous work or exercise for 6 weeks post-surgery. It is recommended to have someone at your home who can assist you.


Aspirin Containing Products and
Herbs and Natural Products
Ginkgo biloba
Alka Seltzer
Dong Quai
European Mistletoe
Pepto Bismal
Focus-kelp, black tang
Coumadin (Warfarin)
Horse chestnut
Northern prickly ash
Talwin Compound
Flurbiprofen Sodium
Vitamin E


General Comfort

It is important for you to get up, move around the house, and take some deep breaths 4-6 times a day from day 1 after the operation. Plan to sleep on your back with your head elevated, if possible. Sleeping on your side will cause swelling on the side you are laying on. Making yourself a nest with pillows can be very helpful.

Some people experience a slight sore throat or mild cough for 2-3 days after surgery. This is a side effect of anaesthesia and should resolve in 48-72 hours.

Pain Management

The first night and day after surgery will be your most uncomfortable. The pain will then stabilize over the next 24-48 hours and then decrease day by day. Analgesia appropriate to the type of surgery will be prescribed for you. Report to the doctor if you have unbearable pain. You will heal faster if you are not tense and tired from pain.

Stool softener may be helpful for patients who develop constipation as result of opioid pain killers. You can progress to regular strength paracetamol as your pain subsides. Narcotics will interact with alcohol so do not drink at the same time you are taking them. Drains are used in 80% to 90% of our surgeries to prevent post-operative swelling and fluid buildup. You will be instructed in drain care before leaving the hospital.

The initial drainage will be bloody, changing to clear red then to clear yellow over the next 3-5 days. If blood clots in the tube, it can be cleared by applying pressure and “milking” the tube toward the bulb. Be careful not to put tension on the tube where it enters the wound. If you have less than 30mls of drainage in 24 hours before your first post-op appointment
you may call the office to make an appointment to have them removed.

Wound Care

• There is no need to change a clean, dry dressing for the first 2-3 days after surgery.
• It is preferable to have your 1st dressing change at the doctor’s office.
• You may shower after the original dressings and drains have been removed. Your doctor will give any other wound care instructions to you at the time of your surgery.
• Keep your supportive Bra on consistently for the first 6 weeks.


Please call or come into the consulting room or the Emergency Department when the clinic is closed as soon as possible if you have:

Increasing swelling, redness, or pain in the breasts.
Pus drainage from the breasts.
Excessive bleeding post-op (i.e., bandages become soaked with blood).
Shortness of breath.
Fever greater than 38 degrees orally.
Activity Limitations After Surgery

There should be no reaching above your shoulders, twisting or lifting more than 5 pounds for three weeks. No heavy activity or exercise for three weeks. Any activity that makes your face flush or makes you sweat can make you swell. No soaking your incisions (bathing or hot tubs) until your Steri-Strips® are removed, your sutures have been removed, and all scabs are healed.

After three weeks, you may resume normal activities. Do not wear underwire bras for 4 to 6 weeks after surgery, and then it is a matter of personal choice.

Scar Care

• Scar development is a process that lasts up to a year or more after surgery.
• Apply Micropore tape scars for a period of up to 6 months if possible.
• Use silicone base gel to massage the scar.
• Use clothing and sunscreen to protect the scars.
• Report any scars that you find unacceptable.
• Need to ask a question, email doctor on . We are here to help.


Get In Touch With Us

Don’t wait any longer to achieve your aesthetic goals. Reach out to us today and let us show you how we can help you.

Visit Us

Suite 304
24 12th Avenue
Linksfield West

Call Us

011 485 4434
066 006 6631

Send Us A Message

First Name
Last Name
The form has been submitted successfully! We will get in touch soon!
There has been some error while submitting the form. Please verify all form fields again.
Scroll to Top