Hand surgery in general is a subspecialty shared by both plastic and orthopaedic surgeons and close links between the two specialities are maintained, particularly through the British Society for Surgery of the Hand. As the treatment of hand conditions becomes more complex, it is important for those involved to be specially trained and four senior registrar posts have been established (two in plastic surgery and two in orthopaedic surgery) for advanced hand surgery training for a period of up to one year.

An increasing number of plastic surgeons are spending more than 50% of their time in hand surgery. The primary treatment of hand trauma frequently requires access to microsurgical facilities for small vessel anastomosis and nerve repair, and such facilities need to be available on a 24 hour per day basis, with adequate staffing to provide such a service. This service is at present best provided, in medium-sized or larger plastic surgery units with appropriate operating facilities and follow-up hand clinics with experienced physiotherapists and occupational therapists on site. This may, therefore, involve transferring patients from other acute hospitals if such facilities and expertise are not available.