Orthopaedic Surgery - Dupuytren's Release

Procedure

Dupuytren’s contracture is a common condition. In most cases, no cause is found, but it more commonly affects white men of middle age or older. There is also a genetic (family) connection, and diabetics are more likely to get it. However, anyone can be affected.

Underneath the skin of the palm and extending into each finger is a sheet of fibrous tissue - this is called fascia. It behaves like a shield, which protects the delicate structures underneath.
Unfortunately, this fascia can become thickened for various reasons and this thickening is called Dupuytren’s contracture.

You may have noticed the fingers bending in towards the palm and getting in the way. You may have reached a joint decision with your surgeon to release the contracture with an operation.

You will be seen by your surgeon before the operation. They will take this opportunity to draw on your hand (mark with a felt pen). This is to ensure the correct hand(s) and finger(s) are operated on. If you have any questions, now may be the correct time to ask them.

An anaesthetic will be given in theatre. This may be a general anaesthetic (where you will be asleep) or a regional block (e.g. where you are awake but the area to be operated is completely numbed). You must discuss this and any risks with the anaesthetist.
 
When in theatre, the skin around your hand will be cleaned with antiseptic fluid and covered by sterile towels (drapes).

A tight band (tourniquet) may be inflated around the upper arm. This is to limit the amount of bleeding. The surgeon will begin by cutting the skin along the tightness / contracture. This cut (incision) will usually be a zigzag shape along the palm and the affected finger. Each surgeon has their own method. You may wish to discuss this beforehand.

Through the incision, the surgeon can separate the skin from the tightness (contracted fascia). When satisfied, the skin can be closed up again. Most surgeons use stitches above the skin. These will have to be removed in 10 to 14 days’ time - an appointment will be made for a check on the wound also.

You may well have a plaster on the hand when you come out of theatre. Some surgeons will remove this cast after a short while and ask you to wear a splint.

You will be encouraged to perform exercises to gain maximum movement. This may be shown to you by a hand or physiotherapist.

Full recovery may never be achieved or may take many months, but the position of the finger should be greatly improved. You should be aware that the recurrence (return) of this contracture is high.

Please be aware that a surgeon other than the consultant, but with adequate training or supervision may perform the operation.

Alternative procedure

Continued physio/occupational therapy to increase stretching and splinting (especially at nighttime) may be useful.

However, if the disease has progressed, surgery may be the best option. There are many types of surgical procedure that can be done. You should discuss these with your surgeon

Risks

As with all procedures this carries some risks and complications.

Common (1-5%)

Pain

The procedure does involve moving soft tissue and will hurt afterwards. It is important to discuss this with the staff and ask for pain killers if needed. The scar itself can be painful.

Bleeding

There will inevitably be some bleeding. Do not be alarmed if you see some spotting of blood on the bandage or cast that you leave with. If the bleeding becomes any greater, then you should contact your doctor or nurse.

Scar

The operation will leave a thin scar on the palm and finger. These may be painful. Massaging with moisturiser once the wounds have healed is often helpful at softening them and decreasing the pain.

Recurrence

The likelihood of Dupuytren’s contracture happening again - even in the same hand/ finger are high (around 10%). The harder you work with the therapists, the less likely this is.

Rare (<1%)

Infection

This may present as redness, discharge, or temperature around the wound. A course of antibiotics may be necessary.

Thick/keloid scar

These are scars which grow excessively thick, red and raised. They occur in some people and cannot be predicted although if you have a previous keloid scar you are at greater risk. Scars may be treated with steroid injection or surgically if necessary.

Delayed wound healing

May occur if the wound is under tension, infected or short of blood supply.

Fat necrosis

This is also a cause of delayed wound healing.

Damage to tendons

These run under the wound and can be cut.

CRP syndrome

This is a disorder which usually happens after surgery or other injury. The skin can become very painful - even to light touch or movement.

Numbness

There are important nerves that run along the fingers. These give feeling (sensation). They can be attached to the thickenings or can be damaged during the operation. This may leave you with numbness of the fingers or hand or occasionally some weakness.