In all hand surgery procedures, there is a common denominator: special care with detail, along with a precise and gentle technique; both necessary for success.

Modern advances in magnification permit us to repair fine structures with better perspectives for anatomical and functional reconstruction.

The lesions and the pathology that affect the hand are multiple and involve its different structures.

Lesions of traumatic etiology affect multiple structures, such as the hand skeleton in its different segments. Any phalange, the metacarpals, the bones of the carpo or the bones of the forearm may be damaged. In the same way, trauma may frequently affect joints at different levels.

In the same manner, tendons (flexors and extensors) may be damaged. The peripheral nerves may also be affected by traumatic lesions.

The reconstruction of the different structures mentioned implies particular techniques for each and every one of them, in relationship to individual physiology.

In this way, today’s techniques of osteosynthesis are oriented toward semi rigid reduction with biocompatible materials such as titanium, available in miniplates and screws. 

Nevertheless synthesis with small Kirschner nails are still up to date (such as in the phalanges of the hand). The systems of dynamic traction has been popularized en those cases of multifragment fractures inside or around the bony joints.

The reconstruction of tendons has evolved in order to preserve tendinous circulation through tendinous vinculum and blood circulation through parathenon. This is achieved by means of peritendinous sutures with more tensile resistance.

Nerve reconstruction through fascicular reconstruction has favored better reinnervation and has allowed better sensitive and motor function.

Microsurgical tissue transfer has allowed reconstruction of different segments of the thoracic limb. As an example of these transfers, we have the transfer of digits form the foot to the hand, osteofaciocutaneous transfers from the forearm, muscular transfers to reestablish miotendinous function of the flexors, and the transfer of vascularized peroneum that has permitted the bony reconstruction of the radius and cubitus (bones of the forearm).

Early treatment of Rheumatoid arthritis has reduced the incapacities and has permitted the conservation of function of Rheumatic hands by means of what has been called Prophylactic Surgery.

The paralytic hand has found a better horizon with the reconstruction regimes applied to increase function in peripheral and central problems.