Dupuytren’s Fasciectomy

Summary

This operation is performed for Dupuytren’s disease.  The aim of the operation is to remove the abnormally thickened tissue in the palm or finger. This leads to a straighter finger and an improvement in function.

Factors to Consider

Symptoms from Dupuytren’s disease vary significantly between patients.  Many people will find that the position of the finger gets in the way during day to day tasks.  Without treatment the bend will typically get worse, though the timescale can be very variable. The severity of your symptoms will dictate whether you should proceed to surgery.

Non-surgical treatments such stretching and splints are typically not effective. There are a number of surgcial options which are suitable in different situations. These include needle fasciotomy, collagenase (Xiapex) injection and fasciectomy . Your surgeon will be able to discuss which of these are the most appropriate, though for many it will be fasciectomy. 

It is possible that this procedure can be re-done if the disease recurs and is troublesome. A skin graft is sometimes needed in these circumstances which is taken from the upper arm.

Description of Surgery

The operation can usually be performed as a daycase procedure but you will need to ensure that there is someone to drop you off and pick you up from the hospital.  You will also need to have a responsible adult at home with you on the night of the operation.

The operation is performed through a incisions that run up the finger from the palm.  The surgeon will then identify the nerves to the fingers and remove the abnormal tissue whilst protecting these.  The finger is usually straighter after this, though a release of the first finger knuckle joint (proximal interphalangeal joint) may be required if it is also stiff.  

Anaesthetic

The operation is usually performed under a general or regional anaesthetic and so you will be given instructions as to when you need to stop eating and drinking (normally the night before) before you come into hospital.  

Your pain can be well controlled with local anaesthetic given during the operation or the regional anaesthetic.

What are the risks?

All operations involve an element of risk.  The risks for this particular operation are small but it is important that you are aware of them.

The risk of infection is very small and is thought to be less than 1%.  Most infections will settle simply with antibiotics.

Damage to nerves and blood vessels to the finger can occur, though the risk of them being divided is about 1%..

The finger position is usually much improved, though it may not go fully straight and this is more common with involvement of the proximal interphalangeal joint.

Some stiffness and swelling is common and usually resolves rapidly with elevation and movement of the fingers. Complex regional pain syndrome is a rare complication that may cause more prolonged pain, stiffness or swelling.

There is no cure for Dupuytren’s disease and it will often recur over a number of years. Rarely this can be more rapid.

After Surgery

Pain

Local anaesthetic will be used during the operation and so you will feel comfortable when you first wake up.  This can last up to 12 hours but the elbow may be sore after it wears off.  You will be given a combination of pain killers to go home with.  It is important that you take regular pain relief so that you can start moving your arm early.  

Dressings

You will wake up with your arm in a bulky bandage and there may be a plaster cast underneath.

The wound is closed using non-dissolvable stitches.  They will be removed by the therapists between 10-14 days. 

You may be given a sling to help keep the hand up whilst walking about. This helps reduce swelling, but you can come out of it to move the shoulder and elbow.

Physiotherapy

The cast will be removed at about 1-2 weeks by the hand therapy team.  The hand is then free to move and the therapist will help you to mobilise the hand.

Driving

You can drive when you feel you are safe to drive.  This means that you feel confident that you have full control of your car and are able to swerve out of the way of something in the road.  This will vary between patients but normally will be after 2 weeks.  

Return to work

This depends on what your job is.  You should be able to return to a “desk job” within a couple of weeks of your surgery.  If you have a heavy manual job it can take up to 6 weeks before you feel ready to return to work.  Please discuss this further with your surgeon or physiotherapist if you feel unsure.  A sick note can be given to you at the time of your surgery if required.  Please ask the nurses on the ward if you need one.

What to expect

Your finger should be improved straight away, though it may take a few weeks before it feels back to normal.