Abstract
Solonen and Vilkki (2002) provided a detailed historical account in this Journal. The Finnish Society for the Surgery of the Hand (FSSH) was founded in 1976. In addition to the annual meeting, the society organizes national training and courses. The first Finnish textbook on hand surgery was published in 2000 and the revised edition in 2016. Among the current 115 members, 87 are active hand surgeons, 31 having a PhD degree, 14 having associate professor status, and three having personal professorships. There is no professorship of hand surgery in Finland. Five members have been entitled ‘Pioneer of Hand Surgery’ by the International Federation of Societies for Surgery of the Hand: Kauko Vainio, Kauko Solonen, Henry Brummer, Simo Vilkki, and Martti Vastamäki.
Current major practice
We treat a multitude of congenital, traumatic, inflammatory and degenerative disorders of the upper extremity. The daily work involves treatment of various bone and soft tissue injuries, overuse injuries, degenerative arthritis and compression neuropathy.
The most common surgical procedures of the hand are carpal tunnel decompression and trigger finger release, which are, however, also performed by other surgeons and their trainees. A routine practice also includes microscopic and arthroscopic techniques, whereas surface replacement prostheses of the hand and wrist are seldom used. Excluding the demanding reconstructive and microsurgical procedures, a vast part of elective and non-complicated trauma surgery procedures are performed on an outpatient basis. The incidence of some diseases and injuries, such as Dupuytren contracture and distal radius fractures, is relatively high in Scandinavian countries.
Training and hand surgery services
The current population of Finland is 5.5 million. Hand surgery is one of the 11 independent surgical specialities in Finland. An independent specialty has a positive effect on education, training, research, and the level of clinical care. Specialization in hand surgery takes 6 years. After medical school, a 9-month public healthcare service and a 27-month general surgical training are required. This is followed by 3 years of training in one of the five university hospitals. No prior specialization in orthopaedic or plastic surgery is required. Currently there are 11 hand surgical training positions. At the end, the trainee has to pass a written examination. The Finnish specialization programme corresponds closely to the requirements set by the European Board of Hand Surgery.
There is a hand surgical unit in all five university hospitals (Helsinki, Turku, Tampere, Kuopio, and Oulu). Hand surgical services are also available in most regional central hospitals. There is also a substantial private sector contribution. The emergency microsurgical hand surgery service is provided in the University Hospitals of Helsinki, Tampere, and Oulu. Approximately 100 revascularizations and replantations of the hand or its parts are performed each year in those hospitals. Furthermore, complicated microvascular and tetraplegic upper extremity reconstructions are centralized at the Helsinki and Tampere University Hospitals. In recent years, only a few microvascular toe-to-hand transplantations have been annually performed for adults and children. The number has decreased due to a well-functioning replantation service over the country. Annually, there are about ten adult patients with brachial plexus reconstructions, ten with obstetrical brachial plexus, and ten patients having surgeries for upper extremity of tetraplegia.