Hand Reconstruction Surgery

Reconstruction starts from the tasks your hand has lost. Tendons, nerves, skin and bone follow from there.

A meta-analysis of 2,997 digital nerve repairs found no technique clearly better than another, so the length of the gap and what can be spared for a graft decide the method.

What hand reconstruction covers

Reconstruction differs from first aid.

The emergency repair of a cut tendon or a reattached finger happens in the first hours or days after an accident, while reconstruction is the planned work that comes weeks, months or years later, when scar, stiffness, missing tissue or a nerve that never recovered stands between you and a working hand. A crushed hand may need new skin cover first, then freed tendons, then a joint procedure, in a sequence spread over a year, and each stage depends on the one before it having healed and on the joints staying supple through hand therapy in between. Surgeons start from the tasks you have lost, holding a cup, buttoning a shirt, writing, gripping a tool at work, and work backward to the structures that make those tasks possible. Two hands with similar injuries can therefore end with quite different plans, because a pianist, a builder and a retired teacher do not need the same things from the same fingers.

Patients come for reconstruction after

• crush, saw and machine injuries,
• burns that left tight scar across the palm or fingers,
• nerve injuries in the arm that did not recover,
• tendon repairs that ruptured or stuck,
• and differences present from birth, such as joined fingers or a missing thumb.

The building blocks of reconstruction

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Cover first, movement second, power last.

Spare parts come from your own body. Common donors include

• a small forearm tendon most people can spare,
• a long thin tendon from the calf,
• a sensory nerve from the back of the leg,
• and skin from the groin, forearm or inner arm.

Rebuilding tendons

Repaired tendons can stick to the scar around them or pull apart. A 2012 meta-analysis of flexor tendon repairs found reoperation in 6 percent, rupture in 4 percent and adhesions in 4 percent. Tenolysis frees a tendon that is stuck but intact, and therapy starts within days to keep it gliding.

Two-stage grafts

Where scar has closed the tendon tunnel, the graft goes in over two operations.

Nerves and nerve transfers

Feeling takes time.

Where a large nerve high in the arm will not recover in time, a working branch close to the paralyzed muscle is redirected into it, a nerve transfer, which shortens the distance the nerve has to regrow. Muscles that have waited too long without a nerve cannot be brought back that way.

Tendon transfers for paralysis

When a nerve injury has left muscles permanently weak, a tendon transfer reroutes a working muscle to do the job of a paralyzed one. After radial nerve palsy, for example, forearm muscles that bend the wrist are moved to lift the wrist, the fingers and the thumb, and similar transfers restore pinch and thumb opposition after median or ulnar nerve palsy. The donor muscle must be strong, expendable and moving in the right direction. Joints must already move freely.

Skin cover and burn contractures

Tendons, nerves and joints need healthy cover before anything else is rebuilt. Small defects close with skin grafts or local flaps moved from next to the wound, larger ones with a flap from the forearm or the groin that stays attached for a few weeks before it is divided, and the biggest with a free flap joined to vessels at the wrist, which our microsurgery page covers.

Burn scars that tighten across the palm or the web spaces pull fingers into fixed positions. Release of the scar with grafts or Z-shaped skin rearrangements, followed by night splints and pressure garments for months, opens the hand again.

Rebuilding a thumb

Your thumb carries much of the hand's function, so losing it changes everything you pinch and grip. Options depend on how much is missing, from lengthening what remains or deepening the web space, through moving the great toe or second toe to the hand with microsurgery, to repositioning the index finger as a thumb, pollicization, which is done mostly in children born without a working thumb. For fingertip and thumb pulp loss, a small free flap from the toe pulp is one option, and a 2026 review of 1,300 such flaps found a pooled survival rate of 99.8 percent, with cold intolerance in 26.3 percent of the patients assessed, while most people walk normally on the foot once the donor site has healed and the toe transfer leaves a gap that shoes hide. Children adapt fast after pollicization and use the new thumb within months. The new thumb grows with the hand.

The foot gives up a little, the hand gains a lot.

Getting ready

Risks

Therapy and recovery

Hand therapy does as much as the operation.

Your therapist makes a custom splint in the first days, teaches an exercise program that protects the repair while keeping it moving, and changes the program week by week as healing allows, so the hand gets enough movement to stop scar binding it and not so much that a repair pulls apart. Tendon grafts and transfers need ten to twelve weeks of guided therapy, nerve recovery runs for a year or more, and a staged reconstruction takes a year from first operation to final result, with your local therapist continuing the program between visits to Istanbul. Expect tiredness and frustration in the middle weeks, when the splint still restricts you and progress seems slow, and keep in mind that the measurements the therapist takes each week, how far each finger bends and how strong the grip is, show gains that are hard to notice from one day to the next.

Results build slowly.

How long to stay in Istanbul

One to three weeks per stage.

Published hand surgery packages in Istanbul list two to three days in hospital for joint and bone procedures, with a five-day visit for a small joint arthroplasty. Splint fitting and early therapy add days. Staged reconstructions mean two or more trips spaced by months. Fitness to fly is checked before you leave, with the wound dry, the splint comfortable, the hand raised on the flight and, after a toe transfer, a walking plan for the airport.

What decides the cost

How many stages, the procedures in each, grafts or implants, nights in hospital and the number of therapy sessions in Istanbul set most of the figure.

Published packages list hospitalization, anesthesia, surgical materials, airport transfers and an interpreter. Hotel nights and diagnostic tests are billed separately at several centers. Your quote should name each stage and its procedures, and that figure comes only from a hand surgeon reading your photos, X-rays and earlier operation notes.

The review costs nothing.

Arranging the trip

A WhatsApp message to the coordinator opens the case, and that coordinator stays with it through every stage of the reconstruction, between trips and after. English, Arabic, French, Russian, Serbian, Romanian and Spanish are spoken, with an interpreter for other languages. One companion sleeps in your room on a companion bed, and the international office books a nearby hotel, sends a visa invitation letter ten days before travel and meets you at the airport. Halal, vegetarian and diabetic meals, a prayer room and a female physician on request are all available.

Once you are back home

Your local therapist follows the written program, and videos of the hand moving reach the surgeon through the coordinator so the next stage is timed well.

A flap that turns pale, blue or cold, a wound that opens, spreading redness or fever, or a sudden loss of movement after a tendon repair. Each needs a doctor the same day.

Hand reconstruction surgery FAQ