Dupuytren’s disease surgery

Dupuytren’s disease is a condition of the palmar fascia, a fibrous layer lying beneath the skin of the palm. The fascia gradually thickens, first forming nodules and then cords that extend towards the fingers. Over time these cords contract and pull the fingers into flexion, so that they can no longer straighten fully. The ring and little fingers are most often affected.

Surgical treatment, called fasciectomy, consists of removing the diseased tissue to release the fingers. At Detalii Med in Baia Mare, the procedure is performed by Dr Marius Pruna and Dr Valeria Pruna.

Surgery is discussed when the disease begins to affect hand function, for example when:

• one or more fingers can no longer straighten fully;
• the patient can no longer lay the hand flat on a table;
• the bent fingers get in the way when washing, wearing gloves, putting the hand in a pocket or during daily and work activities;
• the bending of the fingers increases over time.

A nodule without finger contracture does not usually mean that surgery is needed; in such cases the doctor may recommend monitoring.

Fasciectomy aims to remove the cords that pull the fingers and to improve their extension, for a hand that is easier to use. How much a finger can be straightened depends on the degree and duration of the contracture and on the joints involved.

The operation does not cure the disease itself. Dupuytren’s disease can recur in the operated area or appear in other parts of the palm, even after a successful procedure. In long-standing contractures, the finger joints may remain partly stiff, and full extension is not always possible.

At the consultation, the doctor examines the palm and fingers, assesses the position of the nodules and cords, measures how far the fingers have bent and checks sensation and circulation. The onset of the disease, how quickly it has progressed, family history, associated conditions and the patient’s activities are discussed.

The patient is asked about medication, especially medicines that affect blood clotting, and about allergies. The doctor explains whether surgery is indicated now, what can realistically be expected, the risk of recurrence and what recovery involves, including any exercises or physiotherapy sessions.

The surgeon makes one or more incisions in the palm and the affected finger, carefully identifies the nerves and blood vessels in the area and removes the diseased fibrous tissue. Sometimes zigzag incisions or skin rearrangement techniques are used to close the wound, depending on the case.

The wound is closed with stitches and the hand is covered with a dressing and, if needed, a splint. The length of the procedure varies with the number of fingers and the extent of the disease. Most often the patient goes home on the same day.

The procedure is usually performed under regional anaesthesia, which numbs the arm, or under local anaesthesia, depending on the extent of the disease. The patient should not feel pain during the operation. The type of anaesthesia is decided at the consultation.

Recovery after fasciectomy has two parts: wound care and restoring mobility.

• in the first few days, the hand is kept raised to reduce swelling;
• the dressing is changed and the wound checked at the agreed intervals, and stitches are removed, as a guide, after about two weeks;
• exercises or physiotherapy sessions are often recommended, sometimes with a night splint, to keep the fingers straight;
• light activities are resumed gradually, and effort with the hand after a few weeks, depending on healing.

Following the recommended exercises plays an important part in the final result.

Like any surgical procedure, fasciectomy carries risks, which are discussed in detail at the consultation:

• bleeding, haematoma or infection;
• delayed skin healing, especially where the skin was attached to the fibrous cord;
• numbness of a finger due to nerve injury or, rarely, circulation problems in the finger;
• stiffness, prolonged swelling or tenderness at the scar;
• complex regional pain syndrome, a rare complication;
• recurrence of the disease or its appearance in other areas.

Improved finger extension is usually seen immediately after the operation, but the final result takes shape over several weeks or months, as the wound heals, swelling subsides and mobility is restored through exercise.

The scars mature over a few months. Because the disease can recur, it is helpful for the patient to return for a check-up if nodules reappear or the fingers start to bend again.

Dupuytren’s disease gradually pulls the fingers into flexion through thickening of the palmar fascia. Fasciectomy is considered when the fingers can no longer straighten and hand function is affected. The result depends on the stage of the disease, and recovery includes wound care and, often, exercises or physiotherapy. The disease can recur, so follow-up over time is important. The indication and treatment plan are agreed at the consultation at Detalii Med.