HAND SURGERY IN SWEDEN
Hand surgery became a clinical board speciality in Sweden in 1969 as a result of pioneer work by, among others, Erik Moberg and Nils Carstam, and hand centers were subsequently founded at all University hospitals in Sweden. Today there is a national organization ensuring available emergency teams on call for hand injuries 24 hours daily. According to current organization and agreements with the orthopaedic departments in Sweden, all major hand surgery cases are referred to the hand centers for specialist treatment. Among such cases are major and severe upper extremity trauma, flexor tendon injuries, lesions to major nerve trunks and the brachial plexus as well as injuries requiring microvascular reconstruction. Secondary reconstruction such acute cases are also a major part of hand surgery. A large number of other conditions and diseases are also treated at departments of Hand Surgery. Examples are treatment of hand-arm dysfunction in cerebral palsy (botulinumtoxin and surgery) and congential anomalies.

To achieve an optimal treatment, there is a strong link between clinical hand surgery and academic hand surgery including teaching, research and development. Experimental and clinical research has a strong position in Swedish hand surgery, and there is a well developed network with research and clinical hand centres in north and south America, Europe, Africa and Asia.

 CLINICAL HAND SURGERY IN MALMÖ
The clinical Hand Unit in Malmö is since 1962 an independent unit at Skåne University Hospital. Since 2009 the hand surgeons in Malmö and Lund are organised into one unit. It is one of the largest clinical hand units in Sweden, serving a population of about 1.7 million people in southern Sweden. All major upper extremity trauma from this region is referred to our unit. Although the main interest is focused on hand trauma and reconstructive hand surgery, all kinds of elective hand surgery are covered. Much time is devoted to secondary reconstructive procedures, wrist problems, nerve entrapments, congenital malformations, spastic conditions in children and Dupuytren's contracture. We also have a great interest in rheumatoid surgery, especially difficult cases requiring advanced arthroplastic procedures. Some of the cases are judged and done in collaboration with Departments of Orthopaedic Surgery, Plastic Surgery, Pediatrics and Department of Hand Surgery in Umeå. A close collaboration, with respect to cases with cerebral palsy, brachial plexus birth palsy and congenital anomalies, is conducted with Child Habilitation units in the region.

A BUILDING DESIGNED FOR HAND SURGERY
Since 1991 the department in Malmö is located in a new six floor building specially designed and equipped for hand surgery. The department occupies 5 floors, each of them covering 750 square meters.

The department also have clinical and research activities in Lund. The sixth floor in Malmö is devoted to surgery. There are five surgical theatres designed for hand surgery, two of them equipped with operating microscopes. There is also a small postoperative care unit covering nine beds.

On the fifth floor the patient ward is situated.

On the fourth floor the Hand Rehabilitation Unit is located. Occupational therapists, physiotherapists and social workers work here on a team basis, co-operating in the process of treating hand patients in various rehabilitation programs. Work Simulators are available for training of specific manoevres and grip functions as well as for objective evaluation of the patient's ability to carry out specific tasks. There is also an equipment for tactilometry (vibrometry), i.e. analysis of the vibrotactile sense of the hand and foot within multiple frequencies. See also Clinical Projects.

Administration facilities and doctors' officies as well as the chief´s secretary and university secretary are located on the third floor. On this floor there is also a well equipped library, and room facilities devoted to computer work.

The out-patient clinic is situated on the first floor. It is designed to allow several doctors to run their clinics parallelly. There are small surgical theatres for minor surgical procedures.

The hand building is linked to the Medical Research Center (MFC) with one lecture room with 95 seats and an auditorium containing 300 seats. The laboratory, where experimental projects are run, is located in the Wallenberg laboratory, and Clinical Research Center (CRC) 250 meters from the Hand Surgery building.

CLINICAL RESEARCH PROJECTS
The clinical research projects are related to diagnosis, treatment, rehabilitation, assessment of hand function and costs with emphasis on nerve injury and repair. Special interest is paid to the interactive hand and brain, and to the influence of diabetes on the nervous system and hand function. Besides nerve-related projects focus is orchestrated on scaphoid fractures, artificial joints and thought-controlled artificial hands.

EXPERIMENTAL RESEARCH PROJECTS
At present, our experimental research projects are carried out at the Wallenberg Laboratory and CRC (Clinical Research Centre) at Skåne University Hospital, Malmö. Several of the staff members are active in various projects in this department. We welcome foreign visiting scientists in our laboratory. There is also a close collaboration with laboratories in Lund, especially Department of Biology. In addition, we are presently funded by EU to develop a new bioartificial tube to reconstruct nerve defects.

A significant part of hand injuries consists of peripheral nerve trauma varying from nerve compression lesions to complete transections and root avulsions at brachial plexus level. These injuries are extremely difficult to treat and the functional outcome is generally poor, especially in adults. Defects in nerve continuity require autologous nerve grafting.

Our project addresses peripheral nerve injuries from a holistic standpoint taking into account the whole perspective – “from molecule to man” – with special focus on pathophysiological events such as post traumatic metabolic shifts and phenotypic changes in neurons and non-neuronal cells after compression and transection in both healthy and diabetic models. We address methods aiming at finding alternatives to nerve grafts. Immunohistochemistry is used to study regulation of transcription factors (e.g. ATF-3, c-jun) and neuropeptides in neurons, early Schwann cell response (Erk 1/2 related to proliferation, HSP27 related to neuroprotection and cleaved caspase 3 as a marker for apoptosis) and nerve fibre regeneration. Such events are also investigated in diabetes.