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HAND. Carpal Tunnel

The first symptoms of CTS may appear when sleeping, and typically include numbness and paresthesia (a burning and tingling sensation in the fingers, especially the thumb, index, and middle fingers).[3] These symptoms appear at night because many people sleep with bent wrists which further compresses the carpal tunnel. If the median nerve is already under stress, the increased compression of the bent wrist creates the numbness and tingling. Difficulty gripping and making a fist, dropping objects, and weakness are symptoms of progression. In early stages of CTS individuals often mistakenly blame the tingling and numbness on restricted blood circulation and they believe their hands are simply “falling asleep”.

It is important to note that unless numbness or paresthesia are among the predominant symptoms, it is unlikely the symptoms are primarily caused by carpal tunnel syndrome. In effect, pain of any type, location, or severity with the absence of significant numbness or paresthesia is not likely to fall under this diagnosis.

Clinical assessment by history taking and physical examination can frequently diagnose CTS.

  • Phalen’s maneuver is performed by flexing the wrist gently as far as possible, then holding this position and awaiting symptoms. A positive test is one that results in numbness in the median nerve distribution. The quicker the numbness starts, the more advanced the condition.
  • Tinel’s sign, a classic, though less specific test, is a way to detect irritated nerves. Tinel’s is performed by lightly tapping (percussing) the area over the nerve to elicit a sensation of tingling or “pins and needles” in the nerve distribution.
  • The carpal compression test, or applying firm pressure of the palm over the nerve to elicit symptoms has also been proposed.
  • If, based on history and physical examination, a CTS diagnosis is suspected but not clear, patients will likely be tested electrodiagnostically with nerve conduction studies and electromyography; MRI or ultrasound imaging are also used.

If symptoms resolve with non-surgical interventions, surgery can be avoided. If not, then the “carpal tunnel release” surgery is recommended.


HAND. Dupuytren Disease

Symptoms of Dupuytren’s disease usually include a small lump or series of lumps and pits within the palm. The lumps are generally firm and adherent to the skin. Gradually a cord may develop, extending from the palm into one or more fingers, with the ring and little fingers most commonly affected. These cords may be mistaken for tendons, but they actually lie between the skin and the tendons. In many cases, both hands are affected, although the degree of involvement may vary.

The initial nodules may produce discomfort that usually resolves, but Dupuytren’s disease is not typically painful. The disease may first be noticed because of difficulty placing the hand flat on an even surface, such as a tabletop. As the fingers are drawn into the palm, one may notice increasing difficulty with activities such as washing, wearing gloves, shaking hands, and putting hands into pockets. Progression is unpredictable. Some individuals will have only small lumps or cords while others will develop severely bent fingers. More severe disease often occurs with an earlier age of onset.

Various surgical techniques are available in order to correct finger position. Your treating surgeon will discuss the method most appropriate for your condition based upon the stage of the disease and the joints involved. The goal of surgery is to improve finger position and thereby hand function. Despite surgery, the disease process may recur and the fingers may begin to bend into the palm once again. Before surgery, your treating surgeon will discuss realistic goals and results.


RECONSTRUCTIVE. Skin cancer

While skin cancers can be found on any part of the body, about 80 percent appear on the face, head, or neck, where they can be disfiguring as well as dangerous.

The primary cause of skin cancer is ultraviolet radiation -most often from the sun, but also from artificial sources like sunlamps and tanning booths.

Anyone can get skin cancer-no matter what your skin type, race or age, no matter where you live or what you do.

Basal and squamous cell carcinomas can vary widely in appearance. The cancer may begin as small, white or pink nodule or bumps; it can be smooth and shiny, waxy, or pitted on the surface. Or it might appear as a red spot that’s rough, dry, or scaly…a firm, red lump that may form a crust…a crusted group of nodules…a sore that bleeds or doesn’t heal after two to four weeks…or a white patch that looks like scar tissue.

Malignant melanoma is usually signaled by a change in the size, shape, or color of an existing mole, or as a new growth on normal skin. Watch for the “ABCD” warning signs of melanoma: Asymmetry-a growth with unmatched halves; Border irregularity-ragged or blurred edges; Color-a mottled appearance, with shades of tan, brown, and black, sometimes mixed with red, white, or blue; and Diameter- a growth more than 6 millimeters across (about the size of a pencil eraser), or any unusual increase in size.

Skin cancer is diagnosed by removing all or part of the growth and examining its cells under a microscope.

Most skin cancers are removed surgically. The procedure may be a simple excision, which usually leaves a thin, barely visible scar. Or curettage and desiccation may be performed. When the lesions are larger a more complex surguical reconstruction may be hended.

If you are in doubt you can ask for an assessment with us.


RECONSTRUCTIVE. Scar Revision

Scars -whether they’re caused by accidents or by surgery- are unpredictable. The way a scar develops depends as much on how your body heals as it does on the original injury or on the surgeon’s skills. Not all the scars are the same and they may be treated with different methods.

If you’re bothered by a scar, your first step should be to consult us. Your surgeon will examine you and discuss the possible methods of treating your scar, the risks and benefits involved and the possible outcomes. Please do not hesitate to ask any questions or express any concerns you may have.


RECONSTRUCTIVE. Breast Reconstruction

We believe that breast reconstruction begins before the cancer is even diagnosed. You need to know that the majority of the breast cancer develops in patients without family history of this disease. It is only 5-10% of the breast cancer patients who are due to a genetic mutation.

Perhaps you have heard of BRCA1 & BRCA2 genes.
In 1990, DNA linkage studies on large families with the above characteristics identified the first gene associated with breast cancer. Scientists named this gene “breast cancer 1” or BRCA1 (pronounced brak-uh). BRCA1 is located on chromosome 17. Mutations in the gene are transmitted in an autosomal dominant pattern in a family.

Since it was clear that not all breast cancer families were linked to BRCA1, studies continued and in 1994, scientists discovered another gene (similar to BRCA1) and named it BRCA2. BRCA2 is located on chromosome 13. Mutations in this gene are also transmitted in an autosomal dominant pattern in a family.
When a person has one altered or mutated copy of either the BRCA1 or BRCA2 gene, their risk for various types of cancer increases:

BRCA1 Mutation

  • 50 percent to 85 percent lifetime risk for breast cancer
  • 40 percent to 60 percent lifetime risk for second breast cancer (not reappearance of first tumour)
  • 20 percent to 60 percent lifetime risk for ovarian cancer
  • increased risk for other cancer types, such as prostate cancer

BRCA2 Mutation

  • 59 percent to 82 percent lifetime risk for breast cancer (in females)
  • 6 percent lifetime risk for breast cancer (in males)
  • up to 27 percent lifetime risk for ovarian cancer
  • increased risk for other cancer types, such as pancreatic, prostate, laryngeal, stomach cancer, and melanoma

These genes can be detected in a simple blood test and it take about 4 to 6 weeks.

  • If you are younger than 50 y/o , you have family history of both breast and ovarian cancer, prostate cancer, male breast cancer or Ashkenazi Jewish ancestry you may be interested in having your genes tested for BRCA1 or BRCA2.
  • From the moment your blood is taken it takes about a month to know the results.
  • If you don´t have BRCA1 or 2 your risk of having breast cancer still exists as the rest of the normal population.

As a patient who has had a mastectomy done, we will consider your case 4 months after your chemotherapy is finished and 6 months after your radiotherapy is finished. This will allow your tissues and general health to be fit for a reconstructive procedure.

We will require a document form your oncologist that states that you are tumor free before we consider you for reconstruction.

There is a variation of methods that can be used for this procerure and this will depend on your general health, skin condition, body constitution and your wishes of course. Generally there are two types of breast reconstruction, those performed with autologous tissue(tissue from your own), those performed with anatomical breast prosthesis and those that use the two former techniques.

There are advantages and disadvantages for each of the procedures and as a general rule, the procedures using breast prosthesis are simpler, quicker and easier to recuperate and the ones done with your own tissues are more complex and of longer recovery. The surgical options will have to be discussed between you and your surgeon in detail.