Dupuytren’s Release
What is Dupuytren’s Release?
The hand has a unique fascia which is like a canvas under the skin. Normally it acts to toughen the skin allowing us to twist and grip things without injury. When thickened and contracted the fascia can be removed with an operation called a fasciectomy. The surgery will correct the deformity of the fingers if they have not progressed too far. A zigzag cut is used as a straight incision would contract and the deformity would recur. The scar looks extensive at first sight after the operation but almost completely disappears over a few weeks to months.
If Dupuytren’s contracture has recurred or the Dupuytren’s tissue extends all the way into the skin, it may be necessary to remove the skin altogether and replace it with skin from the forearm. This is called a dermofasciectomy.
Dupuytren’s Release Recovery
Local anaesthetic will be injected into the wound at the end of the operation. This area and the fingers will remain numb for up to six hours after surgery. Before the effect wears off, you should take painkillers which have been prescribed on a regular basis. Your hand will initially be placed in either a bulky dressing, or a plaster splint.
Swelling causes stiffness and pain which is made worse by hanging the arm down at your side or resting it on your lap. Swelling is best prevented by keeping the hand above the level of the heart for the first 48-72 hours.
You will be seen within a few days by the Hand Therapist. The dressings will be removed and the wound will be checked. You will be given advice and exercises to start immediately. Hand elevation remains important to prevent swelling and stiffness of the fingers. Please remember not to walk with your hand dangling, or sit with your hand held in your lap. If the hand becomes red, hot and very swollen you must go to your GP or the Accident and Emergency Department
At this time a Hand Therapist appointment will be made for the following week to check your exercises.
Your stitches are absorbable so they will not need to be removed. If the wound is healing well, you may be referred to the Occupational Therapist for a splint to be worn at night. If a splint is felt to be necessary you should try to wear this for 6 months as this is how long it will take for the scar tissue to fully mature. During the day, the hand should be exercised and you should perform normal activities.
Once the wound has healed it is safe to get the hand wet. The wound and the surrounding skin often become very dry and will be more comfortable if a moisturiser is applied, including on the wound itself. Initially the scar will be thickened and tender to touch. This must be massaged firmly with a moisturising cream to reduce sensitivity and swelling.
After two weeks you may be able to drive a car, as long as you are comfortable and have regained full finger movements; however, it may take longer. Timing of your return to work varies with your occupation and this should be discussed with your therapist.
What can I expect from Dupuytren’s Release?
- More than 95% of patients are happy with the result. However, complications can occur
- Recurrence over a life-time is almost inevitable; however, most patients have a long lasting result that they are happy with
- Incomplete correction of the contraction, the surgery fails to straighten the finger. This is particularly common when there has been a longstanding contracture of more than 90 degrees
- Injury to the blood vessels and nerves to the finger (approximately 1%) may leave one side of the finger numb If this occurs the wound should be explored and if injured, the nerve repaired
- When skin grafts are used (dermofasciectomy), a small number fail to heal
- Infection (Less than 1%), scar pain and Numbness
The One Team Specialists
Anthony Hearnden
Consultant Orthopaedic Surgeon FRCS (Tr&Orth), Shoulder, Elbow, Hand and Wrist
