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Constant Growth, Mentally and Manually

By E. Gene Deune, MD

The residents often asked why I went into Hand Surgery. In medical school, I gravitated towards the technical aspect of surgery of being able to fix things. As a general surgery intern, I could not wait until the end of a case so that I could close the incision, and I looked forward to repairing the complex lacerations that came in during my emergency calls. I went into Plastic Surgery with the same enthusiasm for reconstructing complex wounds. Perhaps I was not well informed, but I did not realize that Hand Surgery was a component of Plastic Surgery until I was a resident. During those years, I felt unprepared for taking care of Hand Surgery problems once I graduated. Because of that, I did a Hand and Microsurgery fellowship for its educational value and to give me another year to figure out what I wanted to do. When I was done in the late 1990s, the politics of Washington DC revolved around socialized medicine and controlling rising medical costs. This severely dampened the medical field, and few were hiring. If they were, it was at low salaries. I remember anesthesiology residents graduating with offering salaries that were two-thirds that of CRNAs’. My first job was in a private practice, doing about half hand surgery and half aesthetics. Since then, as a result of circumstances, I’ve moved back into academics doing solely hand and upper extremity surgery. Hence, I call myself the ‘accidental hand surgeon’ – no puns intended.

What I have realized is that being a hand and upper extremity surgeon allows you the ability to take care of patients from infancy to maturity. It allows you to correct congenital anomalies that can forever change the course of a child’s development. In the case of an Apert’s Syndrome child, to give a hand five digits when there was none, so that child can grow, start playing the piano, and graduate from college. In the hearing-impaired adult with multiple flexor tendon and nerve lacerations, surgery not only restores hand function but their ability to sign, to communicate, and to remain a part of society. In the elderly with severe median nerve compression and thumb CMC joint arthritis who are no longer able to open their medicine bottles or are able to feel their pills, with a carpal tunnel decompression and thumb CMC arthroplasty, you can improve their hand function so they can function independently. For those with upper extremity malignancies, to excise the tumor, reconstruct the soft tissue defect, and to restore function with tendon transfers or innervated muscles, you preserve their limb while giving them hope.

ASSH asked me to write what it means to be a great hand surgeon. To me, it means being able incorporate knowledge about the hand, filter out the critical information, and utilize that knowledge to correct a problem that makes a patient’s life better by preserving or increasing their hand function. It is also about constant growth mentally and manually; of keeping up with the latest developments and incorporating changes into your surgeries. My college’s motto is ‘Mens et Manus’, Latin for mind and hand. Both are important, the mind to think and the hand to translate into action. There have been many who have preceded me in age, knowledge, and experience. They have imparted their knowledge in the books and chapters that I have read and continue to read, and some during my training have directly contributed to my knowledge and surgical ability. Professionally, I would have not have been able to grow without my colleagues’ support and confidence in referring patients with simple and complex problems, and mentally to be always challenged by the residents and the students.

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