Dupuytren's Fasiectomy Procedure

Surgery is the only way of removing the tissue as diet modification, splints, physiotherapy and medicines are ineffective.

Dupuytren’s surgery is usually successful, and people who have the condition in both hands generally return to have the second operation done (it is not routinely recommended to operate on both at the same time. However, because the condition is benign, does not cause major functional problems (the ability to make a fist and grip things is not compromised), and the surgery has a slow recovery, it is an operation that should be considered carefully.

If the contracture of the joint in the finger is over 45 degrees full correction is hard to maintain after the operation. A contracture of the knuckle joint at the bottom of the finger is usually fully corrected, markedly improving the finger position.

Injury to a nerve in a finger during the operation can occur, resulting in numbness. If the nerve is divided it will be repaired and the sensation usually gradually returns (at least partially) over a few months.

The surgery is often quite extensive, so problems with swelling and stiffness afterwards can be quite significant. At least 5% of people will have a slow recovery.

Unfortunately, there is a moderately high rate of recurrence of the Dupuytren’s tissue, either at the same site or elsewhere in the hand. People who are under 50 have a higher risk of recurrence.

Some people experience discomfort in bad and very cold weather. This can be permanent, and a significant problem. It is more likely to occur and be troublesome if you smoke.

Fasciectomy

The Dupuytren’s is removed through a long zig-zag incision from the base of the palm to beyond the end of the thickened tissue. Dissolving stitches are routinely used to close the skin. The operation can be done using a regional anaesthetic (the whole arm is numbed) or sometimes a general anaesthetic, with local anaesthetic given at the end of the operation to minimise any post-operative pain. The dressings leave the fingers that have not been operated on free to move normally.

Sometimes part of the wound in the palm is intentionally left open (when the palmar tissue is very dense, and the scar would be tight) and this will need dressings for about three weeks until it heals. Surprisingly this reduces pain and swelling and leaves a perfectly acceptable scar afterwards.

Dermofasciectomy

For severe or recurrent Dupuytren’s disease consultants will occasionally excise the skin with the Dupuytren’s tissue and use a skin graft taken from the forearm to cover this. This is more extensive surgery with a longer recovery and increased risk of problems at the graft donor site and with the graft itself.

The hand must be elevated for 48 hours when still but should be moved and used as normally as possible. The affected fingers can be bent and stretched with the other hand. Any pain after the operation usually settles if the hand is kept elevated. Painkillers may be needed for the first few days.

Occasionally the swelling is severe, prolonged and associated with pain, due to the development of the poorly understood condition called complex regional pain syndrome (CRPS). This occurs unpredictably and is treated by physiotherapy and pain medication. Occasionally it leads to long-term stiffness and disability, compromising the function of the hand permanently.

The dressings are changed after about five days (usually with the hand therapist) and a thermoplastic splint is made to be worn at night. Hand therapy will be arranged at the nearest hospital available. You should wear the splint at night for as long as you think it is of benefit (i.e. your finger is straighter in the morning than when you went to bed). This may be around three months.

The scar will remain tender for at least two months, and it should be massaged with cream (lanolin, E45, Double Base) regularly. In about 10% of people the scar, after healing well initially, thickens and becomes itchy, red and more painful after the first month.  If this happens the scar settling down to normal, thin, mobile skin can take more than a year.

Occasionally excessive bleeding, causing a painful swollen wound (haematoma) or delayed healing may slow down the recovery. A few people react to the dissolving suture material, and this can lead to localised areas of tenderness and swelling that persist for a couple of months.

Please be prepared to not drive for a minimum of two weeks. After this it is up to you to decide when you feel confident to do so.

Manual workers normally need about six weeks off work, but office employees will be able to return sooner.

Signs of wound infection may develop after a few days, with increasing pain, swelling and redness. Seek advice from your GP as treatment with antibiotics is usually sufficient.