A Guide to Dupuytren's Contracture Release Surgery

Dupuytren's Contracture is a relatively common condition that affects about 5% to 25% of people worldwide. The prevalence tends to increase with age, and it is more commonly seen in individuals of European descent.

In this blog post, we will explore the various aspects of Dupuytren's contracture一from its causes and diagnosis to non-surgical treatments and the surgical intervention known as Dupuytren's contracture release. 

What is Dupuytren’s Contracture?

Dupuytren's Contracture is a hand condition characterized by the progressive thickening and contracture of the connective tissues in the palm. This results in the formation of nodules or cords, causing the fingers to bend inward and limiting their range of motion. Other symptoms include:

  • Finger contracture
  • Limited range of motion
  • Grip strength reduction
  • Functional limitations
  • Pain and discomfort

While the exact cause is unknown, certain risk factors, such as genetics, age, and gender, can increase the likelihood of developing this condition.

How is Dupuyren’s Contracture diagnosed?

Dupuytren's contracture is typically diagnosed through a combination of medical history assessment and physical examination. 

A hand surgeon or orthopedic specialist will conduct a thorough physical examination of your hand(s). They will evaluate it through palpation, finger flexion, and hand function.

In some cases, additional imaging tests such as ultrasound or magnetic resonance imaging (MRI) may be ordered to evaluate the extent of the disease further or to assess the involvement of deeper structures.

What are the non-surgical treatment options for Dupuytren’s contracture?

Surgery is often the most effective treatment for severe cases of Dupuytren's contracture. However, non-surgical options may still be considered in the early stages of mild cases. 

While these treatments cannot reverse the disease, they aim to alleviate symptoms, slow disease progression, and improve hand function. Some common non-surgical treatment options include collagenase injections, stretching therapy, and dynamic splinting.

What is Dupuytren's contracture release?

Surgical intervention may be necessary when non-surgical options fail to provide satisfactory results or the contractures become severe. Dupuytren's contracture release surgery aims to remove the diseased connective tissue, releasing the contracted fingers and restoring hand function. 

Several surgical techniques are available, and the choice of method depends on factors such as the severity and complexity of the contractures.

  1. Fasciectomy

This is the most common surgical technique for Dupuytren's contracture. It involves removing the diseased connective tissue (fascia) in the palm and fingers. The surgeon makes an incision in the palm and carefully excises the affected tissue. 

In some cases, skin grafts or flaps may be required to cover the surgical site. Fasciectomy can be performed as either a partial (removing part of the fascia) or a total (removing all affected fascia) procedure.

  1. Fasciotomy

Fasciotomy is another surgical technique used to release the contractures in Dupuytren's contracture. Instead of removing the entire diseased tissue, the surgeon strategically makes small incisions in the palm and fingers to release the contracted bands. 

This technique provides immediate relief and improved finger extension. However, the contractures may eventually recur over time.

  1. Needle aponeurotomy (needle fasciotomy)

Needle aponeurotomy, or percutaneous needle fasciotomy or percutaneous aponeurotomy, is a minimally invasive surgical technique. The surgeon uses a small needle to puncture and divide the contracted tissue bands. 

This technique is performed under local anesthesia and can be suitable for selected cases with specific contracture patterns. Needle aponeurotomy provides temporary relief, and the contractures may reoccur in the future.

  1. Dermofasciectomy

Dermofasciectomy combines the removal of the diseased fascia with the excision of the overlying skin. This technique is usually reserved for cases with significant skin involvement, such as severe contractures or recurrent Dupuytren's disease. T

he surgeon removes the affected fascia, along with a layer of skin, and then closes the wound using skin grafts or flaps.

  1. Limited open fasciectomy

Limited open fasciectomy is a modified approach to fasciectomy. Instead of making a long incision in the palm, the surgeon makes smaller incisions to access and remove the diseased tissue in specific locations. 

This technique minimizes scarring and improves recovery time while effectively releasing the contractures.

How to prepare for a Dupuytren’s contracture release procedure?

Before undergoing Dupuytren's contracture release surgery, your healthcare provider will evaluate your candidacy for the procedure. This evaluation may involve a thorough medical history review, physical examination, and possibly additional tests. 

Additionally, you will be informed about the expected outcomes, potential risks, and complications associated with the surgery. Pre-operative preparations may include discontinuing certain medications, adjusting lifestyle habits, and arranging post-operative care and support. 

It's important to follow your healthcare provider's instructions carefully to ensure a smooth surgical experience.

How is the surgery performed?

During Dupuytren's contracture release surgery, the goal is to surgically release the contracted tissue bands in the palm and fingers, allowing for improved finger extension and restoring hand function. 

While specific details may vary depending on the surgical technique used, here is a general overview of what happens during the surgery:

  • Before the surgery begins, anesthesia is administered to ensure you are comfortable and pain-free during the procedure. 
  • Once the anesthesia has taken effect, the surgeon starts making an incision in the palm. The location and length of the incision may depend on the specific technique employed and the extent of the contractures. 
  • After making the incision, the surgeon carefully dissects the layers of skin, fat, and tissue to expose the contracted fascia. They will then remove or release the affected fascia and cords responsible for the contractures. The extent of tissue removal depends on the chosen surgical technique and the severity of the contractures.
  • Depending on the specific circumstances and the extent of the disease, additional procedures may be performed alongside the contracture release. These may include methods such as skin grafting, flap techniques, or joint capsule releases. 
  • Once the necessary tissue release and modifications have been made, the surgeon carefully closes the incision using sutures or other closure techniques. 
  • Following the surgery, the hand is typically dressed with a sterile bandage or dressing to protect the surgical site. 

What to expect after the procedure?

Proper post-surgical care and rehabilitation are vital for optimizing outcomes and restoring hand function. You will receive detailed instructions on wound care, pain management, and the use of splints or dressings. 

Hand therapy and rehabilitation exercises are typically prescribed to improve range of motion, strength, and function. Physical therapy sessions may be necessary to regain optimal hand function. 

It's essential to follow the recommended rehabilitation plan, attend follow-up appointments, and communicate any concerns or issues to your healthcare provider.

Frequently asked questions on Dupuytren’s contracture release surgery

How long does the surgery take?

The duration of the surgery varies depending on the severity and complexity of the contractures, but it typically takes one to two hours.

What is the recovery time after the surgery?

The recovery time can vary, but most individuals can expect several weeks to months for a full recovery. Hand therapy and rehabilitation are often recommended to optimize healing and restore hand function.

Will there be scarring after the surgery?

While some scarring is inevitable, efforts are made to minimize scarring and optimize wound healing. Your surgeon will provide guidance on postoperative care to promote proper healing and reduce scarring as much as possible.

What are the risks associated with the surgery?

Potential risks include infection, bleeding, nerve damage, stiffness, recurrence of contractures, and scarring. Your surgeon will discuss these risks with you before the procedure.

Will the surgery completely eliminate Dupuytren's contracture?

Surgery can effectively release the contracted tissue, improving finger extension and hand function. However, it does not cure Dupuytren's contracture, and there is a possibility of recurrence in the future.

OSC of Panther Creek  - The best orthopedic surgery center in the Triangle

At the Orthopaedic Surgery Center of Panther Creek, your safety and well-being are our top priorities. With our state-of-the-art surgery centers, you can trust that you are in the hands of experienced professionals dedicated to providing high-quality care. 

Our center prioritizes patient education, ensuring you have a thorough understanding of your condition and treatment options. Our commitment to excellence positions our surgery centers as leaders in the state, offering top-notch care and advanced surgical solutions. 

Our orthopedic surgeons and staff look forward to guiding you toward optimal health and recovery. Contact us to learn more!

The material contained on this site is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE, and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions or concerns you may have regarding your health.

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