Dupuytren’s surgery

Dupuytren's disease is a thickening of the palmar fascia, which is a connective tissue layer in the palm of the hand. The palmar fascia is a continuation of the palmaris longus tendon into the palm. Palmar fascia serves an important function which allows humans to have firm, non-mobile skin in the palms and feet to allow for power grip.

In certain patients, genetics causes a thickening of the polymer fascia. This may start off as a simple bump but progress overtime to a thickened cord which eventually pulls down the finger into a flexed position.

Surgery is required either when the hand can no longer be placed flat on a tabletop (this is called the “tabletop” test), or when any flexion of the proximal interphalangeal joint occurs. When there is a joint flexion, correction becomes more difficult and so intervention is required to correct joint flexion before permanent stiffness sets in.

What is involved in Dupuytren’s surgery?

In certain situations you may be a candidate for a needle upon your autonomy, which means that numbing open anesthesia is injected followed by a sharp needle used to break apart the cord and allow the finger to extend.

In other situations, you may need a full surgery which involves a Palmer fasciectomy. This means that a long zig-zag incision is made over the entire record and it is surgically removed from the surrounding tissues. This may be done under general anesthesia or local anesthesia depending on the severity of the case.

What are the benefits of surgery?

Restoring finger extension and range of motion, and prevention of permanent stiffness.

What is recovery like after Dupuytren’s Surgery?

Everyone's recovery is different and the following message is in no way a guarantee that your recovery will follow this trajectory. At the end of surgery you will be placed in a splint that will keep your fingers straight. This is to be kept on until follow up with your surgeon, which will occur around 1 week post-operatively. You will start hand therapy as soon as possible to help fight off the stiffness. You will have sutures that will need to be removed at the two-week mark.

You must not overuse your hand after surgery. No repetitive activities, lifting more than 5 lbs, sports, weightlifting, or exercise. It is recommended to take at least two weeks off of work. At the two-week mark, you may return to modified duties, with only light use of the hands. No heavy lifting for six weeks period from 2 to 4 weeks you will gradually progress through activities that work with the goal of reaching for activities by the six-week mark. You may not drive until your pain has subsided and you can make a full fist to safely grip steering wheel.

Hand therapy is mandatory after Dupuytren’s surgery. Dr. Barkho will coordinate this with you after surgery.

What are the risks of surgery?

Dupuytren surgery is a serious operation and has several risks. These include:

  • Infection - Bacteria enter the wound grow. This may require antibiotics or further surgery.	
  • Skin necrosis - This means that the blood flow to the skin has been damaged and the skin turns black and dies off. This may require a long time to heal with dressing changes
  • Incision dehiscence – The incision may split open requiring a long time to heal with dressing changes
  • Permanent stiffness - The goal of surgery is to improve range of motion however the opposite may occur. This typically happens if participation in postoperative hand therapy is not possible. This may lead to permanent stiffness and it is possible your hand may be more stiff than the original surgery, making you worse off
  • Nerve damage - the diseased fascia exists very closely to the surrounding digital nerves. These are the nerves that give you feeling to the tips of your fingers. It is normal to feel temporary numbness after surgery which returns over several weeks. Rarely, you may have permanent numbness and or chronic pain due to a direct injury to the digital nerve. This is extremely rare, but possible
  • Death of the finger - in cases where the condition is very severe with a finger that is flexed all the way into the palm, or in a finger that has had multiple  operations, the finger may die off. This happens due to damage to the blood vessels (the digital arteries) to the finger.

Preparation

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