You are looking for a formally qualified plastic surgeon with microsurgical training, who does hand work regularly, who operates somewhere with proper magnification and instruments, and who has a hand therapist available to you afterwards. That last point is not an afterthought. Therapy decides how much of a good repair you actually get to use, so a surgeon who cannot arrange it is offering you half a treatment.
Which qualifications matter in India?
Plastic surgery is a recognised super speciality here. The training route is an M.Ch. in Plastic Surgery following a general surgery qualification, or a DNB in Plastic Surgery from the National Board of Examinations. Either, held by a doctor registered with the state medical council, tells you the person completed a supervised programme covering hand and reconstructive work. Orthopaedic surgeons with dedicated hand training also do this work in some centres.
What does not qualify is a weekend course, a certificate from a private institute, or general surgical experience alone. Ask which qualification the surgeon holds and where it was awarded. Nobody who has earned it objects to the question.
Beyond the degree, ask about microsurgical training specifically. Nerve repair is done under a microscope or high magnification loupes with sutures finer than a hair, and that is a learned skill rather than something a general operating list teaches you.
Why does regular hand work matter?
Deciding whether the nerve ends can be joined directly or need a graft, recognising a nerve that has scarred rather than healed, judging which nerve transfer to use in a late case, handling tendon and artery injuries in the same wound, all of this comes from doing hand cases often. A surgeon who sees hands a few times a year is working from memory rather than from practice.
You usually cannot verify volumes, and you should be sceptical of impressive figures offered without records. What you can do is ask plainly whether the surgeon operates on hand injuries routinely, whether they see the patient through the whole recovery themselves, and whether they handle late and failed repairs as well as fresh ones.
Does the hospital setup matter?
Considerably. Ask what magnification is available, since nerve repair without a microscope or good loupes is not the same operation. Ask whether the theatre stocks fine sutures and the instruments for nerve work, and whether nerve grafting or transfer could be done in the same sitting if the injury turns out to be worse than expected on the table.
For a fresh injury, ask how quickly you can be operated. Timing matters in nerve repair, and a centre that can take you within a reasonable window is worth more than one that offers a distant date.
Then ask about hand therapy. Is a hand therapist attached to the practice or available nearby? How soon after surgery would you be seen, and how often? Splinting, controlled movement and later sensory re education are not optional extras, and they need someone who works with hands specifically rather than general physiotherapy.
What should you ask in the consultation?
- Which nerve do you think is injured, and how did you determine that?
- Do you expect a direct repair, a graft or a transfer, and what decides it?
- What magnification and what setup will be used?
- Will you do the operation yourself, and who assists?
- What is the plan if the injury is more extensive than expected?
- Realistically, how much sensation and power might return, and over what period?
- Who provides hand therapy, when does it start, and how many sessions are likely?
- What restrictions will I have at work, and for how long?
- May I have a written estimate before admission?
Listen for honesty about limits. A surgeon who tells you recovery is slow, measured in months, usually partial, and dependent on the level of injury and your age is describing nerve surgery accurately. That is reassuring, not discouraging.
What are the warning signs?
Be cautious of anyone who promises that feeling will come back fully, or who gives you a confident date for it. Be cautious of a plan that involves only medicines, injections or physiotherapy for a hand that has been numb since a cut, since no medicine reconnects a divided nerve. Be cautious if nobody examines your sensation carefully, area by area, before advising you.
Other signs to slow down for are pressure to decide immediately, a price that keeps shifting, no written estimate before admission, vagueness about where the surgery will be done, and no answer at all about therapy afterwards. Photographs and stories about other patients are not a substitute for an examination of your hand.
What if the injury was months ago?
Late presentation is common in India and is not a reason to stay away. The options change, since direct repair may no longer be possible and grafting or a nerve transfer may be considered, and muscle wasting affects what is achievable. Take every paper you have, including the notes from wherever the wound was first stitched, because knowing exactly what was done and when genuinely changes the plan. A second opinion is reasonable, and no competent surgeon minds it.
Be wary, though, of spending months collecting opinions. In nerve surgery the calendar is part of the treatment, and a decision taken reasonably quickly with one well qualified surgeon usually serves you better than a slow tour of several. Ask each one the same questions, compare the answers, and give particular weight to whoever examined your hand most carefully rather than to whoever sounded most confident.
About the clinic in Surat
Dr. Ashutosh Shah is a Plastic, Reconstructive and Cosmetic Surgeon in Surat, Gujarat, with more than 22 years of surgical experience. He holds an M.Ch. in Plastic Surgery from The Maharaja Sayajirao University of Baroda and a DNB from the National Board of Examinations, New Delhi, and has microvascular and replantation training, with the highest volume of replantations among his cohort in Gujarat. He has trained more than 90 surgeons in hands on workshops and founded Elegance Vidhyalaya. A written estimate is given before admission and enquiries go to WhatsApp.
