Hand and Upper Extremity Surgery

​​Since 2011, the Division of Hand Surgery and Upper Extremity, Orthopedic Reconstructive Microsurgery of Athens Medical Center has been qualified as a European Centre of Excellence dealing with wounds of the Upper Limb (Official European Hand Trauma Center). This certification was given by the Federation of European Societies For Surgery of the Hand which aims to identify and accredit the relevant centers dealing with Hand Trauma all over Europe.

The Surgery of the Hand and of the Upper Limb, is a subspecialty of Orthopedics. Its scope deals with surgical or conservative treatment of all diseases of the Hand and Upper Extremity by the use of a surgical microscope along with special instruments, which permit surgery under high magnification. The technique is particularly necessary in order to reconstruct mutilated extremities, for brachial plexus and peripheral nerve surgery , and also for free tissue transfer (transfer of a portion of skin or muscle from one part of the body to another , transportation of a toe to the hand etc.). Thousands of patients facing problems in the Upper Extremity, as well as others requiring knowledge of Microsurgical skills, were treated as emergency cases . During the last 20 years, more than 80.000 patients were examined and treated in the clinics, while the number of patients treated surgically exceeded 15.000.

 

The objectives of the surgical practice of the department include:

  • Management of Upper Extremity Injuries (from a simple injury to a completely amputated limb).
  • Addressing chronic diseases of the Hand.
  • Addressing chronic diseases of the Elbow and the Shoulder.
  • Reconstructive surgery of peripheral nerves of upper and lower limbs.
  • Reconstructive surgery of traumatic injuries and obstetric brachial plexus palsy.
  • Transfer of vascularized – innervated total tissue thickness flaps (free flaps).
  • Cover of small or large skin defects in the upper and lower extremities.
  • Addressing systemic diseases such as rheumatoid arthritis.
  • Treating tumors of the Upper and Lower Extremity.
  • Arthroscopic Surgery of the Upper Extremity (diagnostic - therapeutic).
  • Treatment of specific diseases where necessary microsurgical techniques is beneficial (femoral head necrosis - free vascularized fibula transfer).
  • Surgical treatment of congenital anomalies of the Upper Extremity.
  • Replacement of the joints in the Upper Limb (shoulder, elbow, wrist, fingers)
  • Restoration of the function as well as of the deformities of the entire human body may require microsurgical techniques.

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ПАЦИЕНТ ПОСЛЕ ПРОИЗВОДСТВЕННОЙ ТРАВМЫ КИСТИ

Athens Medical Center

Dr. Panagiotis Giannakopoulos

  • Visiting Professor in Drexel University, PA, USA
  • Has published more than 100 articles in International scientific Journals and Congresses
  • Former President of the Hellenic Society of Reconstructive Microsurgery

Dr. Adamantios Misitzis

  • Visiting Professor in Orthopaedics, U of L, Jewish Hospital, Kleinert Institute, U.S.A
  • Former President of the Hellenic Society of Surgery of the Hand
  • Former President of the Hellenic Society for Reconstructive Microsurgery

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14.06.16
Athens Medical Center: The "hand and upper extremities surgery seminar” was successfully held for the 10th consecutive year

Upper Extremity Surgeons Adamantios Misitzis (right) and Panagiotis Giannakopoulos (left) with the Managing Director of the Group, Dr. Vasilis Apostolopoulos.

With great success the 10th anniversary of the “Hand and Upper Extremities Surgery Seminar” organized by the Department of Hand - Upper Extremities Surgery and Reconstructive Microsurgery of the Athens Medical Center came to a close. This is an educational activity that brings together participants from Greece and abroad and is organized consistently in recent years. The Department is a center for treatment of traumas of the hand recognized by the Federation of European Societies for Surgery of the Hand (FESSH).

In recent years, a large number of the nation’s Upper Extremity surgeons have been trained at the seminar. Specifically, through the modules of the seminar, participants had the opportunity to attend ten surgical incidents in real time (live surgery) lasting eight and a half hours, to participate in an eight hour exercise in cadaveric preparations and to listen to 38 lectures by distinguished speakers.

The opening speech of the Seminar was made by the Managing Director of the Athens Medical Group, Dr. Vasilis Apostolopoulos, who emphasized the extensive experience and significant expertise of the Department in the field of Microsurgery and in Surgery of the Upper Extremities.

"The large attendance of experienced and trainee Upper Extremity surgeons and especially the praise received are a great honor for us”, stated the Upper Extremities surgeon Panagiotis Giannakopoulos. “All participants, including the renowned orthopedic surgeons Bruno Battiston from Italy and Philip Roure from France, concluded by common consent that the seminar was a particularly valuable learning experience, which proves in practice the commitment of the Athens Medical Group to invest in continuous scientific training” , added the Upper Extremities surgeon, Diamantis Misitzis.

The Seminar was held under the Auspices of the Hellenic College of Orthopaedic Surgeons, the Hellenic Society of Reconstructive Microsurgery, the Hellenic Society for Hand - Upper Extremity Surgery and the Scientific Association of Athens Medical Center.

20.05.14
20 Years – Hand Upper Limb Surgery Department, Orthopedic Repair Microsurgery

The Hand Upper Limb Surgery Department, Orthopedic Repair Microsurgery, under the direction of the orthopedics Mr. Panayiotis Giannakopoulos and Diamantis Misintzis, completed 20 years of operation at the Medical Center of Athens. It was created on May 1993, by a team of doctors, trained for this object, in order to systematically treat traumas and pathologies of the Upper Limb, for the first time in a private hospital of Greece. Operating collectively, they treated thousands of patients with Upper Limb problems, as well as complex problems requiring Microsurgery knowledge, covering on the same time 24/7 the shift of the hospital for emergencies. For those 20 years more than 80.000 patients were examined and treated at the clinics of doctors’ departments, while the number of patients treated surgically surpassed 15.000.

Very important for the Department is considered the presence, from the first years of its operation, of the Orthopedic Surgeon Michalis Ierodiakonos, who with its skills and experience to Children Orthopedics, but also to General Orthopedics, greatly contributed to the successful and effective treatment of the patients.

Hand Surgery and in general Upper Limb Surgery is a specialization of the specialty of Orthopedics. Hand surgery has as its object the surgery or the conservative treatment of all pathologies of the Hand and Upper Limb. These pathologies make a person incapable of executing various functions, necessary for its daily life. They may be caused by injuries or chronic diseases. Upper Limb injuries are a 30% percentage and more of total injuries of the human body, reaching a 60% to 70% of work accidents. This is easy to explain since the hand is the most exposed part of the body and consequently the most vulnerable to injuries. Those could be simple injuries (e.g. isolated bone fracture) or more complex (simultaneous bone, nerves, tendons skin damages, etc.). The immediate treatment of those injuries guarantees the best possible result. Chronic diseases concern syndromes caused by overuse of the hands, systemic diseases, tumors and many other.

For the best surgical practice, the skill of Microsurgery Technique is necessary.

According to it, with the use of a surgical microscope and special thin tools are achieved high levels of magnification for the purpose of surgeries. This technique is necessary in a series of surgeries, such as the «re-attachment» of amputated limbs, brachial plexus and peripheral nerves surgery and the free transfer of tissue (skin part transfer or muscle from one part of the body to the other, leg finger transfer to the hand etc.).

In parallel, the skill of endoscopic surgical methods is deemed necessary, because an increased number of wrist, elbow or shoulder pathologies could be diagnosed and treated with the Arthroscopic approach.

Specifically, the object of surgical practice of the department' doctors includes:

  • Treatment of injuries of the Upper limb (from simple injury, to reattachment of fully amputated limb).
  • Treatment of chronic diseases of the Hand.
  • Treatment of chronic diseases of Elbow and Shoulder.
  • Repair surgery of peripheral nerves of Upper and Lower limbs.
  • Repair surgery of traumatic damages of the Brachial Plexus and obstetric paralysis.
  • Transfer of free flaps.
  • Covering of small or large skin losses to Upper and Lower Limbs.
  • Treatment of systematic diseases such as rheumatoid arthritis.
  • Treatment of tumors of the Upper and Lower Limbs.
  • Arthroscopic Surgery of the Upper Limb (diagnostic- treatment).
  • Treatment of special diseases, where the Microsurgery technique is necessary (avascular necrosis- fibula free flap transfer).
  • Surgical treatment of congenital anomaly of the Upper Limb.
  • Replacement of Upper limb, shoulder, elbow, wrist, and finger joints (replacement surgery).
  •  Restoration of functional deficiencies and deformities of all the human body, where is required the microsurgery technique.

For those 20 years, more than 80.000 patients were examined, while the number of patients that were treated surgically surpasses 15.000.

The experience of the doctors is also considered important for the treatment of war injuries, since lately were successfully treated hundreds of injured persons heavily injured.

Training activities of the department are high level, with continuous presence of the department’s doctors to Greek and international conferences. Of special importance is the Seminar of Applied Upper Limb Surgery, organized successfully by the department since 2007. In this seminar mainly orthopedic doctors are trained in Upper Limb Surgery. It includes 3 parts: display of surgical cases with live image transfer from the Operation Room in Maroussi, to the amphitheater of the Medical Group of Athens in Kefalari, speeches of distinguished speakers for Greece and abroad and practical exercise to cadaver hands.

The 7 Seminars that have been organized up to now, have trained more than 350 doctors to Upper Limb surgery. 

The department’s doctors have a continuous training activity and academic presence, to Greece and abroad, participating to important Conferences and Seminars.

Diamantis Misintzis was the President of the Greek Association of Hand Surgery in 1999 and of the Greek Association or Repair Microsurgery in 2005. On the other hand, Panayiotis Giannakopoulos was President of the Greek Association of Hand Surgery in 2003 and of the Greek Association or Repair Microsurgery in 2009. During their term they have successfully organized international conferences. Additionally, Panayiotis Giannakopoulos was Visiting Professor, to the University of Drexel, in Pittsburgh America on 2011. The Hand Upper Limb Surgery Department, Orthopedic Repair Microsurgery has been certified as Official European Hand Trauma Center, since 2011. This certifications is awarded by the Federation of European Societies For Surgery Of the Hand and aims for the recognition and recording of the treatment centers of Upper Limb trauma in Europe, that satisfy certain Scientific Specifications, in order for the treatment of injuries to be the ideal one.

This certification was awarded for the first time to an organized department of a Private Hospital in Greece. 

19.05.14
Microsurgery Technique

YOUR HANDS WILL ONLY ACHIEVE WHAT YOUR EYES CAN SEE!

Despite the fact that creation and use of vision magnification devices for the observation of the sky and see navigation has been achieved some thousand years now, the first application in medicine was realized by Anton van Leeuwenhoek (1632-1723), who created the first microscope for lab use. The first application for applied surgical reasons was realized by Swedish Otorhinolaryngologists and Neurosurgeons, Nylen, Holmgre and Hinselman, in the 1930s. The revolution took place in 1953, by the German engineer Karl Zeiss, with the creation of the first surgical microscope OPMI 1 (Operative Microscope 1).

The term Microsurgery was born in 1960 by J. Jacobson, D. Miller and E. Suarez, who achieved anastomosis of a vessel of 1 mm diameter and is explained as the execution of operations under the magnification of a surgical microscope. Thus, it is a technique and not a specialty as some people believe. A necessary condition for the use of this surgical practice is the use of micro – tools and micro – sutures. Micro tools are the evolution of the tools of clock-makers and jewelers, because their small size allows for their use under the microscope’s magnification. Micro – sutures of 8/0, 9/0, 10/0 and 11/0 dimensions usually are not visible by the naked eyes. Thus, the Microsurgery is the technique using the three «Μ»: Microscope – Micro-Tools –Micro – Sutures. By using all these modern technology tools it is possible to recognize and operate tissues invisible to the naked eye.

For Upper Limb surgery and generally for the restoration of the musculoskeletal system, microsurgery was used to operate on small vessels and nerves by Orthopedic and Plastic Surgeons. Its first application was the reattachment of amputated fingers. In 1965, Komatsu and Tamai in Japan, achieved the first reattachment of amputated finger in a patient aged 28 years and in 1967 Yang in China made the first successful leg to hand finger transfer.

For the surgery of peripheral nerves, the French Michon in 1964, applied microsurgery for the restoration of injured nerve tissue and the Austrian Millesi, in 1965, used nerve grafts for the bridging of nerve lesions. Another application of microsurgery to Orthopedics and Plastic Surgery is the free transfer of tissues, thus the reception of part of skin or muscle from one part of the body and its transfer to another one. A necessary condition for this transfer is the anastomosis of the blood vessels that secure the blood supply of transferred tissues. Harii in 1972 and Daniel and Taylor in 1973, published the first free tissue transfer. The latest achievement of micro-surgery is the hand transplant, applied for the first time in 1998, in Lyon France, by Dubernard and his colleagues, to evolve to the simultaneous transplant of two hands by Biemer and Hoehnke in Germany in 2008. In Greece, the father lf Microsurgery is considered to be the professor of Orthopedics Mr. Panayiotis Ν. Soukakos, who first applied the method during the '70s and achieved the first finger reattachment in 1979.

From this point microsurgery in Greece presented an important growth and today almost all microsurgical operation are able to be performed with high percentage of success, same with those of worldwide practice. The use of Surgical Microscope is applied by almost all specialties of surgery, such as ophthalmology, otorhinolaryngology, urology, neurosurgery and other, but in a an international level the term «Micro-Surgeon» is used for the Surgeon who handles surgically small vessels and nerves.

Your hands will only achieve what your eyes can see!

What Microsurgery can do today:

  • Amputated hand and finger reattachment.
  • Nerve transection restoration (Final –Final Suture or nerve graft).
  • Intraneural removal of symphysis (intraneural neurolysis).
  • Removal of intraneural tumors.
  • Restoration of bronchial plexus injuries.
  • Free transfer τμήματος of skin or muscle part for covering skin lesion.
  • Free transfer of bone for bridging bone lesion.
  • Free flap bone transfer for the improvement of blood supply in another bone suffering necrosis.
  • Muscle transfer to achieve missing hand function.
  • Transfer of fingers or joints from the leg to the hand, in case of injuries or congenital anomalies.
  • Hand transplant.

Training in Microsurgery is a difficult procedure, which requires calm, patience, self-control and...many hours of exercise! However the result justifies the effort, because the important solutions offered to the patient were not possible under traditional techniques. For daily use, the application of simple magnification, such as magnifying lenses (Loopes), ensures the best visibility, for the recognition and repair of the Upper Limb tissues.