The mainstay of treatment of Dupuytren’s contracture is surgery to remove the involved fascia – a fasciectomy. There is no cure for Dupuytren’s, in that there will always be a tendency for the condition to occur after the fingers are straightened.
Surgery is reserved for people with Dupuytren’s where the contracture is limiting the function of their hands. This will vary widely with people’s occupation and activities.
Dupuytren’s fasciectomy is usually performed under general or regional anaesthetic as day surgery. The hospital will discuss the time of arrival and fasting arrangements. You would not normally have to stop any regular medication prior to this minor procedure but Dr Stewart can advise you about your specific requirements.
Incisions are made over the affected fingers and the thickened facia is excised, taking care to preserve the nerves and blood vessels. If the contracture is severe, a joint release might need to be performed to fully extend the fingers. The skin incision is then modified to close the wound in a zig-zag pattern (z-plasty) to avoid scar contracture.
Normally the hand is dressed and placed in a plaster for the first week. After this, there is quite extensive rehabilitation with the hand therapists involving splinting at night and exercises to regain full finger movement.
The biggest risk in surgery for Dupuytren’s is nerve injury. Because the Dupuytren’s tissue is often quite adherent to the nerves to the fingers, the nerves must be dissected during the surgery. Although nerve injury is rare in Dupuytren’s surgery, temporary nerve dysfunction with numbness of the fingers that resolves after a few days to a few weeks is common.
Alternatives to surgery for Dupuytren’s contracture include needle fasciotomy and collagenase injection. Dr Stewart can discuss these at your consultation.