A short History of Handsurgery with link to video

Abstract

Hand surgery is a combination of microsurgery, osteosynthesis, nerve and tendon surgery focusing on the most essential organ in daily life and in societal interactions: the human hand. A discipline as important and highly specialized as hand surgery must be based on scientific studies and milestones from the past. Our work accompanies the video with english subtitles that was displayed in part during the opening ceremony of the 58th Congress of the Deutsche Gesellschaft für Handchirurgie (DGH, German Society of Hand Surgery) in Munich (President of the conference, Univ.-Prof. Dr. R. Giunta). This paper presents the development of hand surgery from its historical origins, focusing on and introducing important characters from the times of Hippokrates, the Middle Ages, the Renaissance, the 18th and 19th centuries, as well as the two World Wars. In summary, progress of hand surgery is linked to the advances in anatomy, tendon surgery, nerve surgery and closely connected to the necessity of specialized care for upper limb injuries during and after World War II. A well-founded understanding of history and an insight into the development of our specialization underlines the importance of our daily work as hand surgeons and creates new incentives for the future development of hand surgery.

This contribution is published in honor of Ulrich Lanz on occasion of his 80th birthday in november 2020.

Key words

History of hand surgery - Pioneers of hand surgery - Hand surgery in Germany

Introduction

The human hand is a complex organ that we use in everyday life as a tool in nearly all of our activities. In most cases, we use both hands to carry out tasks. Mobility is just as crucial as a sensory function for controlling the most refined motor actions and for literally “grasping” objects. Good everyday function requires the intricate interplay of various tissue structures such as skin, nerves, tendons, and bones. At the same time, the hand–as the human “tool”–is exposed to daily strain and risk of injury. Even minor injuries can cause severe functional limitations. It is often only through injury that many people, as patients, become aware of the significance of the hand in daily life. Hand surgery epitomises highly specialised surgery. It relies on precise anatomical knowledge and, as an organ-focused surgical discipline, combines fracture management, soft-tissue treatment, microsurgical nerve surgery, and vascular surgery.

A large proportion of today’s standards and surgical procedures originates from the period after the Second World War, which provided the decisive impetus for the development of hand surgery. However, the first foundations were laid in Europe–and especially in Germany–during the 19th and early 20th centuries, i.e., prior to the two World Wars [1] . Yet, evidence of its origins can be found much earlier, as the great anatomists of the Middle Ages provided a solid basis for later developments.

This work, conceived as a supplement to the 58th Congress of the German Society for Hand Surgery (DGH) in Munich (Congress President: Univ.-Prof. Dr. R. Giunta), traces the history and development of hand surgery from its earliest fundamentals to the complex organisational structures in modern tertiary-care hospitals. It accompanies a video of the same title, which was presented at the congress opening (Copyright notice: All rights reserved. The video, including all digital and non-digital usage rights, is held by Univ.-Prof. Dr. R. Giunta).

Video

Video 1 https://youtu.be/NBSpwSlBEyI – „Eine Geschichte der Handchirurgie“ from Riccardo Giunta and Ulrich Lanz.

The historical development of hand surgery and its relationship with anatomical science

According to the literature, the origins of hand surgery date back to ancient Greece and Hippocrates around 400 BCE. His Corpus Hippocraticum contains the earliest instructions for the reduction of dislocations and fractures of the hand [2] .

The history of hand surgery is particularly closely linked to the first great anatomists of the Middle Ages. During the Renaissance, Leonardo da Vinci (*1452–†1519) and Andreas Vesalius (*1514–†1564) produced detailed anatomical, scientific, and artistic works and illustrations of individual muscles, bones, blood vessels, and tendons of the hand through the dissection of numerous cadavers.

Impressive drawings by Leonardo da Vinci from the Royal Collection, London [3] . demonstrate his exceptionally subtle anatomical understanding, depicting in great detail the bony structures of the hand, the intrinsic hand musculature, and the differentiation between superficial and deep flexor tendons. Andreas Vesalius published his De Fabrica Corporis Humani Libri Septem in 1543, including illustrations and text on the muscle anatomy of the hand and forearm. Already at that time, he recognised the anatomy of the muscles known to us today, including the M. palmaris brevis . He also described the bony origins and insertions of the musculature, though he still overlooked insertions into fasciae and membranes and failed to appreciate multiple degrees of freedom and vectors of muscles and joints. Moreover, Vesalius mistakenly considered the first metacarpal bone to be the proximal phalanx of the thumb [4] .

Govert Bidloo (*1649–†1713) published in 1685, in Amsterdam, Anatomia Humani Corporis , the largest anatomical collection with printed plates since Vesalius, illustrated by Gerard de Lairesse (*1641–†1711) [5] . Bidloo also studied the anatomy of the forearm and hand in depth and, for example, described the papillary ridges of the fingers. Due to insufficient financial success, the publisher sold the illustrations and text to the English anatomist William Cowper, who republished the work under his own name in 1698 as The Anatomy of Humane Bodies , without mentioning Bidloo or Lairesse in any form. This resulted in one of the greatest plagiarism scandals of the era [6] .

For the diagnosis of hand fractures, the discovery of X-rays and the ability to visualise the skeletal structures of the hand through Konrad Röntgen were of central importance. More than 50 years before the advent of radiographic imaging, however, Gustav Günther (*1801–†1866), through dissections without imaging techniques, had already identified carpal fractures and recognised the relevance of the resulting functional impairments and pain [7] . Günther, professor of surgery at the Universities of Kiel (1837) and Leipzig (1841), published in 1841 the first monograph on the wrist, Das Handgelenk in mechanischer, anatomischer und chirurgischer Beziehung . In this work, he provided the first comprehensive description of the structure and function of the wrist and its joints in all their complexity. Many of his discoveries remained unnoticed and were rediscovered only many years later. More than 100 years before Sennwald et al., [8] he had already recognised the stabilising function of the scaphotriquetral ligament on the capitate and the significance of the TFCC complex and the quadriga effect, the latter being described by Verdan in 1960 [9] ,

Guillaume Dupuytren (*1777–†1835), a French anatomist and one of the founders of modern surgery in France, earned his doctorate with the dissertation Propositions sur quelques points d’anatomie, de physiologie, et d’anatomie pathologique in 1803 in Paris. Dupuytren was an outstanding surgeon and a strict teacher, who treated up to 10 000 patients annually at the Hôtel-Dieu, the largest hospital in Paris, and whose lectures were attended by more than 500 students. The kings Louis XVIII and Charles X appointed Dupuytren as their personal surgeon. In 1823, he was granted the title of Baron. Despite his excellence as a surgeon and a scientist, he was said to have considerable personal shortcomings and pronounced arrogance [10] .

Although the flexion contracture resulting from fibromatosis of the palmar aponeurosis had already been described prior to Dupuytren–by Felix Platter of Basel (1641), Henry Cline (1777), and Astley Cooper (1822)–it nonetheless bears his name today. For treatment, he recommended percutaneous division of the contracture cord. In 1834, the Lancet published the English translation of one of his lectures, including his famous case presentation of a patient treated with his operative technique [11] . The first complete fasciectomy of a finger was performed by William Fergusson (*1808–†1877) in England [12] .

Groundbreaking medical advances between the mid- and late 19th century further propelled the development of hand surgery: the invention of anaesthesia, beginning with ether anaesthesia administered by William Morton at Massachusetts General Hospital in 1846, enabled longer and more complex operations. Friedrich von Esmarch (*1829–†1908) recognised that surgical procedures of the hand could be performed much more safely and precisely with interruption of blood flow. In his 1873 publication Über künstliche Blutleere bei Operationen , he described the principle of “bloodless surgery.” The discovery of X-rays in 1895 by Wilhelm Konrad Röntgen (*1845–†1923) revolutionised the diagnostic possibilities. An improved understanding of microbiology with respect to asepsis and antisepsis, and later the discovery of antibiotics such as penicillin by Alexander Fleming in 1928, enabled increasingly complex interventions and reduced postoperative complication rates.

The evolution of tendon and nerve surgery and its impact on hand surgery

Throughout the history of hand surgery, the sustained anatomical interest over the centuries in the precise depiction of the hand played a crucial role. Building upon this foundation, the steadily advancing developments in tendon and nerve surgery emerged, which today constitute essential components of modern hand surgery.

During the Roman period of antiquity, Galen (*131–†201), physician to gladiators and personal physician to Emperor Marcus Aurelius, described in the Ars Parva that tendons consist of ligaments and nerves. He therefore warned against suturing tendons, asserting that such procedures would provoke pain and convulsions. While Avicenna (*981–†1038), the renowned Persian physician, poet, and philosopher, had already performed and documented detailed tendon operations in the Middle Ages, Galen’s dogma persisted in Europe until the 17th and 18th centuries [13] .

At the beginning of the 19th century, systematic and scientific studies on tactile perception by Ernst Heinrich Weber (*1795–†1878), physician and physiologist in Leipzig, laid the foundations for the field of haptics. In 1834, he published his dissertation De pulsu, resortione, auditu et tactu annotationes anatomicae et physiologicae , in which he examined, among other areas, the psychophysiological performance aspects of the human sense of touch [14] . His investigations into two-point discrimination, in particular, remain essential for understanding the hand, diagnosing nerve injuries, and performing nerve surgery in modern hand surgery.

At the end of the 19th and the beginning of the 20th century, the nerve and tendon surgery of the hand advanced significantly, most notably due to the extensive experience gained in treating the countless injuries to the upper extremity during and after both World Wars–developments that first led to the establishment of hand surgery as a distinct discipline in the United States.

In summary, Adolf Stoffel (*1880–†1937) investigated the anatomy of peripheral nerves and established foundational principles of peripheral nerve surgery, which were later further refined by Otfried Foerster (*1867–†1942). Oskar Vulpius (*1867–†1936) laid the groundwork for modern tendon surgery. Erich Lexer (*1867–†1937) described the basic principles of reconstructive hand surgery in the 1920s and 1930s.

Otto Hilgenfeldt (*1900–†1980) developed a procedure for operative thumb replacement in 1950. Ferdinand Sauerbruch (*1875–†1951) was a pioneer in the prosthetic replacement of the hand.

Oskar Vulpius (*1867–†1936) and Adolf Stoffel (*1880–†1937) in Heidelberg are regarded as pioneering figures in fascicular nerve anatomy, neurotomy, nerve transposition, and tendon surgery. In 1902, Vulpius published Die Sehnenverpflanzung und ihre Verwertung in der Behandlung der Lähmungen , one of the earliest works on muscular substitution procedures, which also included reported cases of tendon transpositions performed for injuries to the extensors and flexors of the hand [15] . Together with Adolf Stoffel, his senior physician, Vulpius, published the Orthopädische Operationslehre in 1913 [16] . The techniques described therein for muscle and nerve transposition long served as operative standards. For example, the book describes nerve transposition in cases of axillary nerve palsy using fascicles of the radial nerve.

Stoffel’s research on the topography of motor and sensory fibres within peripheral nerves was promoted by Vulpius. Even before his orthopaedic–surgical training under Vulpius, Stoffel had developed, through anatomical studies, techniques for neurotomy and nerve transposition. He recognised the distinct functions of sensory and motor nerve fibres and is regarded as one of the pioneers in the study of nerve anatomy [17] [18] .

As noted earlier, the two World Wars, which produced vast numbers of patients with hand injuries, played a major role in the development of hand surgery.

Otfried Foerster (*1867–†1942) treated thousands of nerve injuries during World War I. Although trained as a neurologist–with no formal surgical training–he performed a total of 775 peripheral nerve operations between 1914 and 1920, including nerve reconstructions using N. suralis grafts and numerous nerve transpositions of the upper extremity. He also described the technique of neurolysis and tension-free nerve suturing. Furthermore, he placed great emphasis on postoperative rehabilitation through electrical stimulation and physiotherapy to improve outcomes via cerebral plasticity [19] .

Konrad Biesalski (*1868–†1930), one of the founders of orthopaedic rehabilitation and orthotic technology, published Die physiologische Sehnenverpflanzung in 1916 together with Leo Mayer (*1884–†1972). This work remains one of the fundamental sources on motor substitution procedures. The two physicians increasingly addressed the technical challenges of tendon transpositions, particularly peritendinous adhesions, which they minimised by rerouting donor tendons through the tendon sheath of paralysed muscles [20] .

Hand surgery and World War II

Although surgery on the hand had already been performed in the 19 ^th century and earlier, the term “hand surgery” emerged in the United States during and after the Second World War. Sterling Bunnell (*1882–†1957), who also coined the term “hand surgeon”, played a pivotal role at that time in the successful establishment and training of the first centres for the management of hand injuries.

The number of upper extremity injuries requiring treatment during the Second World War reached unprecedented levels. At the beginning of the war, soldiers with hand injuries were managed inconsistently by plastic surgeons, orthopaedic surgeons, general surgeons, or neurosurgeons, depending on hospital capacities. The need for highly specialised treatment and care delivered by recognised experts to ensure sustainable treatment of these soldiers was quickly acknowledged. As the war progressed, specialised, interdisciplinary hand-surgery units were established, particularly in hospitals operated by the U.S. military. At Cushing General Hospital in Framingham, Massachusetts, the first dedicated hand-surgery ward was created under the direction of the plastic surgeon Captain J William Littler [21] . Owing to the large number of reconstructive and rehabilitative procedures, additional hand centres were rapidly established in nine military hospitals under the leadership of U.S. Army Surgeon General, Major General Norman T. Kirk [21] [22] .

Sterling Bunnell is regarded as the father and founder of modern hand surgery. His textbook, Surgery of the Hand published in 1944, established therapeutic standards for many years. He conducted training courses in hand centres, made regular visits to the nine military hospitals, and supported the founding of the American Society for Surgery of the Hand (ASSH) in 1946, serving as its first president [22] [23] . In reconstructing the hand, he integrated techniques from plastic surgery, orthopaedics, and neurosurgery, emphasising the importance of atraumatic tissue handling in the reconstruction of bones, tendons, nerves, vessels, and muscles of the hand [2] . He trained numerous physicians, became internationally recognised as the leading hand surgeon of his era, and played a decisive role in establishing hand surgery at an international level.

Sterling Bunnell is credited with the well-known rule of “No-Man’s Land” in the hand: no one should, at that time, suture flexor tendons in the region where the superficial and deep flexor tendons run together within a common tendon sheath. This was later modified by Claude Verdan (*1909–†2006) of Lausanne, who began to treat flexor tendons even in this critical region (Zone II according to Verdan).

The actual breakthrough in the treatment of tendon injuries of the hand was achieved by Harold Kleinert (*1921–†2003) from Louisville, USA, in the mid-1960s. He established tendon repair in No-Man’s Land and recognised the critical importance of postoperative management through early passive mobilisation in specialised splints. Kleinert began as a general and vascular surgeon, mastering microsurgical anastomoses of increasingly smaller vessels before dedicating himself fully to hand surgery, the field to which he ultimately devoted his life. In 1962, he performed the first finger revascularisation in Louisville. His work on Zone II flexor tendon repair initiated a paradigm shift. He was also a leading figure in the teaching of hand surgery and, through founding the Christine M. Kleinert Institute for Hand and Microsurgery, facilitated the training of more than 1,400 hand surgeons [24] [25] .

One of the pioneers of German hand surgery, a contemporary of Bunnell and Littler in the United States, was Otto Hilgenfeldt (*1900–†1980). He recognised early the importance of the sensory function of the hand and, based on this insight, developed finger transposition techniques for thumb reconstruction using neurovascular pedicles. In 1950, he published the book Operativer Daumenersatz und Beseitigung von Greifstörungen bei Fingerverlusten , which is one of the most significant German contributions to hand surgery [26] .

Hand surgery during the second World War

The actual beginnings of hand surgery as a defined specialty can be traced to the treatment of large numbers of military patients during the Second World War. Various centres in the United States established clinics for upper extremity injuries between 1939 and 1945. Among them, the centre at Cook County Hospital in Chicago, directed by Michael Mason, and the hand centre in Cushing General Hospital, Framingham, near Boston, under the leadership of the plastic surgeon J. William Littler, became particularly renowned. During World War II, Littler treated nearly 3,000 war casualties with severe injuries to the upper extremity.

After the end of the war, many of the injured servicemen recognised that there was still no independent specialty for treating injuries of the upper extremity and the hand. In collaboration with the Veterans Administration Hospital, the American Association for Hand Surgery (AAHS) was founded in Chicago in 1946. In addition to Littler and Mason, key figures included Sterling Bunnell (*1882–†1957) and Mildred T. Stahl (*1900–†1995). Stahl was one of the leading hand surgeons of her time and an outstanding pioneer in both the hand surgery and the tendon surgery.

Meanwhile, in England–especially in Oxford–the development of hand surgery was shaped by the treatment of those injured and imprisoned during World War II. The Oxford Hand Service was founded by J. Trueta and J. Brooks in 1942, and, thanks to Graham Stack, was further expanded after the war. The Honorary Secretaries of the British Society for Surgery of the Hand (BSSH) included the names Gray Giddins and David Warwick.

In Germany, the founding fathers of hand surgery included Kapandji, Hastem, Hilgenfeldt, Kirchhoff, Strick, Weber-Alfeld, Linoli, Brunelli, Eickenbusch, and Herbert–all of whom made significant contributions to the development of hand surgery following the Second World War.

Hand surgery in Germany following the Second World War

The exchange with American colleagues and the vast experience gathered in the United States led to a growing awareness in Germany of the deficiencies in the treatment of hand injuries after the Second World War and underscored the need for specialised treatment and aftercare. Early on, German physicians had access to Bunnell’s textbook Surgery of the Hand because they had either been prisoners of war in American military hospitals in Germany or–after the war–were themselves treated there as patients. With the help and support of Marc Iselin (*1898–†1987) and Erik Moberg (*1905–†1993), they deepened this knowledge through study visits abroad and through exchanges with other European hand surgeons.

Marc Iselin contributed greatly to the international dissemination of hand surgery beyond the borders of France through his continuing-education courses organised by professional societies, some 300 publications, and numerous lectures at conferences. In 1961, Iselin coined the concept of the “urgence avec opération différée,” meaning a conditional urgency that allows for delayed surgical treatment following the demarcation of nonviable tissues.

Erik Moberg, from Gothenburg in Sweden, was another key pioneer of modern European hand surgery. He coined the phrase “numb fingers make the hand blind.” His name remains closely linked to sensory function testing, particularly two-point discrimination of the fingers. His clinical studies and experiments yielded a conceptually sound foundation for the objective assessment of hand sensory functions.

In Germany, Dieter Buck-Gramcko (*1927–†2012) is considered the leading figure in German hand surgery, and since 2012, the Honorary Lecture of the German Society for Hand Surgery (DGH) has been held in his honour. The first Buck-Gramcko Lecture was delivered by Ulrich Lanz in Düsseldorf in 2012.

Buck-Gramcko founded the “Hand Surgery Literature Circle” in 1959 and, in 1960, the “Hand Surgery Symposium,” from which the DGH later emerged. In 1963, he established the first independent hand surgery department in Germany.

Although only 27 participants from Austria, Germany, and Switzerland attended the first symposia, the meetings became increasingly successful. After symposia in Tübingen (1961), Linz (1962), Munich (1963), Lausanne (1964), and Vienna (1965), participation grew steadily. From 1965 onwards, larger conferences were necessary due to increasing international interest.

At the Vienna symposium on 7 October 1965, several participants expressed the desire for a professional platform enabling hand surgeons to establish themselves more clearly alongside general and orthopaedic surgeons. Consequently, the German-Speaking Working Group for Hand Surgery (DAH) was founded–by Jörg Böhler, Dieter Buck-Gramcko, Walter Christ, Jürgen Geldmacher, Heinz Georg, Klaus Hellmann, Heinz Homann, Hanno Millesi, Henry Nigst, Wolfgang Pieper, Wilhelm Schink, Claude Verdan, Albrecht Wilhelm, and Gottlieb Zrubecky–as a specialty association for hand surgery.

Buck-Gramcko further devoted himself to the treatment of congenital malformations. In connection with the thalidomide scandal in the 1970s, he developed the method of pollicisation for thumb reconstruction. His book, Congenital Malformations of the Hand , published in 1998, is considered one of the standard international reference works.

In 1969, the Zeitschrift für Handchirurgie was established by Mayr Verlag in Erlangen as the official German publication dedicated to the field. It was edited by Buck-Gramcko, Geldmacher, and Scharizer. Thieme Verlag later assumed the publication of the journal under the title Handchirurgie . In 1983, it was merged with the fields of microsurgery and plastic surgery and expanded into the journal now known as Handchirurgie, Mikrochirurgie, and Plastische Chirurgie, published by Thieme.

The importance of microsurgery and the advancement of modern hand surgery

The progress achieved in microsurgery during the mid-20th century opened a new chapter in the history of hand surgery. Only through microsurgery was it possible to overcome the anatomical limitations imposed by local pedicled flaps and to enter the era of replantation. The first successful replantation of a proximal upper extremity was performed by Malt and McKhann in 1962, followed in 1968 by the first successful thumb replantation by Komatsu and Tamai. Since then, replantation teams have been established in major hospitals worldwide.

Hanno Millesi (*1927–†2017) was one of the first surgeons to apply microneural techniques. A recognised expert in brachial plexus and peripheral nerve surgery, he revolutionised interfascicular nerve grafting and microsurgical neurolysis through his innovative methods and numerous fundamental publications. In 1974, he established one of the first replantation services in Europe at his clinic in Vienna. In 1977, together with several colleagues, he became a founding member of the German-Speaking Working Group for Microsurgery of Peripheral Nerves and Vessels (DAM) [30] .

A major breakthrough for replantation surgery in Germany came with the advent of microvascular techniques at the beginning of the 1970s. The ability to suture even the smallest vessels securely–and thereby restore circulation to an amputated or severely injured body part–fundamentally transformed hospital organisational structures. Suddenly, it became necessary to perform microsurgical procedures immediately in order to preserve amputated or critically injured parts of the hand. Such an infrastructure had not previously existed.

In 1975, the first dedicated replantation centres in Germany were established–one in Hamburg under Dieter Buck-Gramcko and one in Munich under Edgar Biemer (*1940). The foundation of these centres was essential for initiating the era of microvascular reconstruction in German hand surgery.

Only with the rise of microsurgery did it become necessary to adapt clinical structures to enable qualified, around-the-clock coverage of severe hand injuries and amputations by surgeons with microsurgical expertise. Yet, integrating such specialised departments into existing hospital infrastructures was often difficult–politically, financially, and administratively. One solution was the creation of entirely new clinics dedicated solely to hand surgery.

Ulrich Lanz (*1940) founded the first independent, and the largest, German clinic for hand surgery in Bad Neustadt in 1992. He established key concepts for wrist surgery, the treatment of distal radius fractures, and numerous other areas of hand surgery. Lanz emphasised that hand surgeons must possess comprehensive knowledge of all relevant tissue structures, both in fracture care and in microsurgery. In Bad Neustadt, he built the largest hand-surgery training centre in Germany. Today, more than 100 hand surgeons trained under his direction work throughout the country–many in leading positions in university hospitals, trauma centres, and other institutions–thus disseminating and further developing the principles he established.

The German Society for hand surgery and perspectives for the future

The German Society for Hand Surgery (DGH) was established in 1990 in response to the need for a national professional association for hand surgery in Germany. This occurred during the 31st Symposium of the German-Speaking Working Group for Hand Surgery (DAH) in Innsbruck and was largely prompted by the founding of the Federation of European Societies for Surgery of the Hand (FESSH) in 1990, which served as a European counterpart to the American Society for Surgery of the Hand (ASSH). The creation of FESSH necessitated the establishment of national societies in Germany and Austria. Professional regulatory authority for hand surgery was thus assigned in Germany to the DGH, while the DAH continued to serve as the scientific link among the national societies.

The 58th annual DGH congress took place in Munich earlier this year, demonstrating how these meetings have developed into internationally recognised events. The British Society for Surgery of the Hand (BSSH), led by Grey Giddins and David Warwick, participated as a guest society. Main topics included hand injuries and trauma centres, wrist arthroscopy, geriatric hand surgery, flap reconstruction of the hand, peripheral nerve surgery, and new surgical techniques and technologies. A panel discussion also focused on the necessity of a dedicated hand surgery specialist.

Since 1992, a supplementary qualification in hand surgery has existed, comprising 3 years of additional training and an extensive surgical catalogue after certification in plastic surgery, orthopaedics, trauma surgery, or general surgery. Despite this, hand surgery has not yet been recognised as an independent surgical specialty. With the revised training regulations now allowing dual board certification, the time has come to grant hand surgery full specialist status in Germany.

The development of hand surgery is far from complete. Hand trauma prevention and the treatment of injuries in specialised hand trauma centres will continue to strengthen the field. Close collaboration between hand surgeons and hand therapists is essential to optimise patient care. Research and clinical science have laid the foundations for these advancements. However, many university hospitals still lack the necessary organisational and infrastructural support to provide optimal care for patients with hand injuries. A functional hand is crucial for participation in social and professional life. Even minor functional deficits make the significance of hand surgery immediately apparent to patients.

From a health policy perspective, hand surgery remains under-recognised and underfunded. Most hospitals still do not have independent organisational structures proportional to the importance of hand care. This is partly due to the relatively small number of hand surgeons advocating for their specialty. It is therefore our responsibility to attract the most talented young physicians to this vital and academically demanding field. As patient expectations grow–driven by increasing specialisation and information access through modern media–the demand for specialist care of hand injuries will continue to rise. Patients have a right to such specialised care, and it is our obligation to ensure its availability for current and future generations.

Acknowledgments

The authors wish to express their sincere gratitude to ARRI Munich and the participating team, particularly the board member Jörg Pohlman and the director and producer Nico Fitzgerald, for enabling the realisation of this project.

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Publication History

Article published online:
13 November 2020