Why Do Plastic Surgeons Do Hand Surgery?
Hand and upper limb surgery has always sat between the skill sets of plastic and orthopaedic surgeons. In Britain, the two specialties have always collaborated to manage both traumatic and non-traumatic hand conditions, including those present at birth.
The hand packs skin, tendons, nerves, blood vessels, bones and joints into a very small space, often within a few millimetres of one another. Restoring its function rarely means repairing only one of these, and the skills it calls for are at the heart of plastic surgery: gentle handling of soft tissue, skin grafts and flaps, and the fine repair of tendons and nerves.
The link was forged in the Second World War. At East Grinstead, Rooksdown House and the other plastic surgery units, surgeons treated large numbers of servicemen with burnt and injured hands, among them RAF aircrew caught in cockpit fires. Gerry Moore at East Grinstead was honoured for his work on hand burns. Getting those hands working again, so that men could return to service or a trade, became a central part of reconstruction.
After the war, plastic surgeons helped build hand surgery into a discipline of its own. Four of the eight founders of the Hand Club in 1952 were plastic surgeons, and the club deliberately balanced plastic and orthopaedic members, a principle the British Society for Surgery of the Hand has kept ever since. Plastic surgeons such as Patrick Clarkson, John Barron and Douglas Campbell Reid became leading figures in the field.
Today hand surgery is an interface specialty, shared between plastic and orthopaedic surgeons and supported by joint training fellowships. Plastic surgeons bring particular expertise in soft-tissue reconstruction and microsurgery, including the replantation of severed fingers, and the hand remains one of the specialty’s core concerns.