There is no effective means by which the course of Dupuytren’s disease can be altered, so the early, nodular stages are usually a case of observation only. Patients are generally seen by a physician every few months to monitor the extent of the condition. In the later stages when finger contractures have formed, surgical intervention is usually recommended. The standard treatment for Dupuytren’s is called a fasciectomy. Fasciectomy is an open surgical procedure involving open removal of the disease or contracted tissue. Removing segments of the diseased fascia helps increase the mobility of the fingers. It is important to consider surgery early on with the onset of any contractures as a delay may require a larger procedure.
Procedure
- Performed under local anesthesia
- An incision is made in the palm
- The thickened cords of the fingers are divided
- The wounds are closed with sutures and a splint is applied.
- In more severe cases, as much abnormal tissue is removed as possible (subtotal palmar fasciectomy). This requires larger “zig-zag” incisions and more extensive wound care and physical therapy.
Goal: Divide tight Dupuytren’s cords to allow for more extension of the involved digits while avoiding a formation of scar tissue.
Who qualifies?
- Patients with contractures of the middle joint.
Benefits
- Outpatient procedure
- Performed under local anesthesia
Recovery
- A splint is applied after surgery and sutures will be removed 7-10 days after the procedure
- Pain, stiffness and swelling may be present after the procedure
- R.I.C.E (link to)
- Hand therapy will be necessary to regain full range of motion of the hand and fingers.
Complications
- Pain
- Infection
- Scar contraction
- Loss of sensation
- Stiffness
- Damage to nerve or blood vessels
The likelihood of complications may increase depending upon
- The severity of the contracture
- The number of contractures addressed in a single procedure
- The presence of any other medical conditions
Outcomes
- Most patients have improved movement
- About 20% of patients experience some degree of contracture recurrence.
- Some patients may require additional surgery.
- The open procedure has an approximate 50% recurrence rate at 5 years
