What is Dupuytren Contracture Release?
Dupuytren contracture release is a surgical procedure to correct the contractures and restore hand function in individuals with Dupuytren's disease. The surgery aims to release the tight cords and remove the affected tissue to improve finger extension and mobility. The procedure can be performed under local, regional or general anaesthesia on an outpatient basis, meaning patients can return home on the same day.
Who is Suitable for Dupuytren Contracture Release?
Dupuytren contracture release is typically considered when conservative treatments, such as hand therapy, splinting, or steroid injections, have failed to halt the progression of the contractures or alleviate symptoms. It is generally recommended for individuals who meet the following criteria:
- Significant contracture progression:
Surgical intervention is often necessary when one or more fingers contracture becomes severe (typically 60 degrees or more at the big knuckles and / or 30 degrees or more at the small knuckles).
- Functional limitations:
If Dupuytren's contracture hampers everyday activities, such as gripping objects, shaking hands, or performing routine tasks, surgical release can help restore hand function.
- Good overall health:
Like any surgical procedure, Dupuytren contracture release requires patients to be in reasonably good health, without significant medical conditions that could increase surgical risks.
What are the Benefits of Dupuytren Contracture Release?
- Restored Hand Function
- Improved Range of Motion
- Enhanced Quality of Life
Types of Dupuytren Contracture Release
- Fasciectomy:
Fasciectomy is the most common surgical technique for Dupuytren contracture release. It involves removing the diseased Dupuytren's tissue, including the affected fascia and cords. Fasciectomy can be performed as a partial or complete removal, depending on the extent of the contractures.
- Needle Aponeurotomy: Needle aponeurotomy, or percutaneous needle fasciotomy (PNF), is a minimally invasive procedure. It involves using a needle to puncture and divide the tight Dupuytren's cords, allowing for the release of the contractures.
- Dermofasciectomy:
Dermofasciectomy is a variant of fasciectomy that involves removing the diseased fascia and the overlying skin. This technique may be necessary when contractures or a disease recurrence significantly affects the skin.
Alternative Options to Dupuytren Contracture Release
Alternative treatments may be considered in less severe cases or when surgical intervention is not immediately necessary. These options include:
- Hand Therapy
- Radiation therapy
Preparations Before Dupuytren Contracture Release
- Schedule a consultation with an orthopaedic surgeon specialising in hand and upper extremity surgery. During this consultation, the surgeon will evaluate the severity of Dupuytren's contracture, discuss treatment options, and determine the most suitable course of action.
- Before undergoing Dupuytren contracture release, a thorough medical evaluation is necessary. This evaluation includes assessing the patient's overall health, reviewing their medical history, and conducting necessary pre-operative tests, such as blood work or imaging studies.
- The surgeon will explain the potential risks and benefits of the surgery, ensuring the patient has a comprehensive understanding of the procedure. It is crucial to ask questions and address concerns to make an informed decision.
- The patient should provide the surgeon with a list of their current medications, including over-the-counter drugs and supplements. Certain medications may need to be temporarily adjusted or discontinued before surgery to minimise the risk of complications.
- Patients may be advised to make certain lifestyle modifications before the surgery. This may include quitting smoking, which can impede the healing process, and adjusting medications that may increase the risk of bleeding or complications during surgery.
- Dupuytren contracture release is typically performed as a day surgery procedure, but arranging transportation to and from the surgical facility is still beneficial. Additionally, a support system can be helpful during the recovery period.
Dupuytren Contracture Release Surgery
- The surgical procedure can be performed under local anaesthesia with or without sedation, regional anaesthesia (such as a nerve block), or in some cases, general anaesthesia. The choice of anaesthesia depends on the patient's preference and the surgeon's recommendation.
- The surgeon will make carefully planned incisions to access the affected area. The specific location and size of the incisions depend on factors such as the extent of the contracture and the surgical technique chosen.
- The surgeon will carefully identify and release the tight cords and diseased connective tissue causing the contractures. In a fasciectomy, the surgeon removes the diseased fascia and cords responsible for the contractures. The extent of removal may vary depending on the severity of the contractures and the surgeon's judgement.
- After the contractures are addressed, the surgeon will close the incisions using sutures. Sterile dressings and a plaster splint are applied to protect the surgical site.
What to Expect After Dupuytren Contracture Release?
After the surgery, patients will be taken to a recovery area for monitoring to ensure comfort. The duration of this monitoring period may vary depending on the individual case and anaesthesia used.
Dupuytren Contracture Release Recovery Plan
- Follow-up Appointments:
Patients will have scheduled follow-up appointments with their surgeon and hand therapist to monitor progress, remove sutures if necessary, and assess overall healing. It is important to attend these appointments as scheduled and communicate any concerns or questions.
- Physical Activity and Restrictions: Patients should follow their surgeon's physical activity and hand-use guidelines. Initially, there may be restrictions on heavy lifting, gripping strenuous activities, or repetitive hand movements. Gradually, as advised by the medical team, patients can resume normal activities.
- Scar Management:
Proper scar care is essential for optimal healing. The surgeon or hand therapist may recommend scar massage techniques, silicone sheets or gels, and sun protection to minimise scar visibility and promote healing.
- Patience and Time: Dupuytren contracture release surgery requires patience and time for complete recovery. Each individual's healing process may vary, but it generally takes several weeks to months to regain full hand function and for the hand to return to its pre-operative state.
Dupuytren Contracture Release Prognosis
In many cases, patients experience significant improvements in hand mobility and range of motion.
Dupuytren's disease tends to recur, even after successful surgery. The recurrence rate can vary but tends to be higher in individuals with more severe disease and a strong family history of Dupuytren's disease. Regular follow-up appointments and long-term monitoring are important to detect and address potential recurrence.
Risks Associated with Dupuytren Contracture Release
- Infection:
As with any surgical procedure, there is a risk of infection at the surgical site. Surgeons take precautions to minimise this risk.
- Bleeding and Hematoma:
Bleeding can occur during or after the surgery. In rare cases, a hematoma (accumulation of blood) may form. Proper surgical technique, careful monitoring, and appropriate wound care can help reduce the risk of excessive bleeding.
- Nerve or Vascular Injury:
There is a slight risk of accidental injury to nerves or blood vessels during the surgery. Surgeons employ meticulous techniques to minimise this risk. Still, in rare cases, nerve or vascular damage may occur, leading to temporary or, in rare instances, permanent sensory deficits or death of the digit, necessitating amputation.
- Scar Formation:
Scarring is a natural part of the healing process. While efforts are made to minimise scar visibility, individual scar formation can vary. Proper scar management techniques can help promote optimal healing and reduce scar-related issues.
Delaying Dupuytren Contracture Release
Delaying Dupuytren contracture release can lead to further contracture progression and functional limitations. The severity of the contractures may increase, making the surgery more complex and potentially reducing the overall effectiveness of the procedure.
With delayed treatment, individuals may experience ongoing difficulties with hand function, reduced grip strength, and limitations in performing daily activities. Timely intervention is crucial to address these issues and prevent further deterioration.
If Dupuytren's disease is causing functional limitations or impacting the quality of life, it is essential to seek medical advice promptly. An orthopaedic surgeon specialising in hand and upper extremity surgery can provide personalised recommendations based on the individual's unique condition.