Dupuytren surgery

Surgical treatment is considered when the contracture significantly affects hand function, notably when the patient can no longer place the hand flat. Since Dupuytren’s disease is hereditary, there is a risk of recurrence after surgery (40-60%) and of progression of the disease to other fingers. Surgical options include fasciotomy and fasciectomy.

Fasciotomy

Fasciotomy involves cutting the contracted cord under the skin with a scalpel or needle, under a mild local anaesthetic. This technique is less invasive and enables rapid recovery. However, it does not remove the diseased tissue, which means the risk of recurrence is very high. This procedure is reserved for certain forms of fibrous cords only.

Fasciectomy

Fasciectomy is a more complex procedure involving the removal of the cords by opening the palm and/or fingers. It offers longer-lasting results with a lower risk of recurrence, but requires anesthesia and a longer recovery period. This method is used in more advanced cases, or where the cords are deep and close to nerves and vessels. When the contracture is significant, it is often necessary to perform a local skin flap locally to close the surgical incisions, or more rarely a skin graft. Your hand surgeon is expert at assessing the best surgical approach and type of skin flap/plasty, and will explain the procedure in detail.

It’s best not to wait too long to treat Dupuytren’s disease, because in severe forms (fingers flexing in the palm), surgery is more difficult and risky. Before undergoing Dupuytren’s surgery, it is advisable to stop smoking to promote tissue healing and avoid compromising the vascularization of the flaps.

Your surgeon may recommend that you temporarily stop taking certain medications (such as anticoagulants) to minimize the risk of bleeding.

Dr. Bejic performs Dupuytren’s surgery most of the time at the Nyon GHOL hospital or clinic de Genolier. Anesthesia (general or axillary block) is administered by the anesthetist. The duration of the operation can vary from 30 minutes to 2 hours, depending on the procedure and its complexity. In complex cases, involving several affected fingers, skin flaps or grafts, patients are kept under observation in hospital for 24 to 48 hours.

Sometimes, the surgeon may leave part of the scar open in the palm, to prevent complications such as haematomas.

After Dupuytren surgery, the patient is monitored 1 or 2 times a week for dressing changes at the Leman Hand Clinic, until the tissues have healed (2 to 3 weeks). During this period, the patient is encouraged to move the fingers and use the hand freely. It is important to keep the dressing dry to avoid infection. A night splint, custom-made by the occupational therapist, is recommended for 6 weeks, to keep the fingers straight after surgery. The patient benefits from personalized occupational therapy follow-up to recover full finger mobility and treat scarring. The occupational therapist may also suggest ultrasound or LED light therapy during the healing phase. Rehabilitation improves hand function, reduces swelling and accelerates healing.

Like all surgery, Dupuytren’s operation carries risks.

The likelihood of complications increases with the severity of the contractures, the number of contractures treated at the same time, the presence of other pathologies and active smoking.

Risks and complications include

• Stiffness requiring rehabilitation exercises
• Temporary loss of sensation due to stretching of contracted nerves
• wound infection and bleeding
• Nerve and/or vascular damage
• Algodystrophy (Sudeck’s disease)
• Loss of viability of a finger: exceptional

The hand surgeon discusses these risks with the patient and takes steps to minimize them, to ensure a safe and effective operation.

Results after aponeurectomy are generally good, with a significant improvement in hand function. The majority of patients regain better hand mobility for daily activities.

However, residual pain or finger stiffness are possible. Hand therapiy and regular follow-up are essential to optimize long-term results.

If you have any questions about hand and wrist surgery, or would like to discuss treatment options for Dupuytren’s disease, please do not hesitate to contact our clinic.

Useful links:

• The British Society for Surgery of the Hand