Dupuytren's contracture - surgery

What is Dupuytren's contracture?

Dupuytren's contracture is a chronic condition of unknown cause characterized by the thickening of the palmar fascia. Over time, nodules and fibrous cords form within the palm.

These changes can lead to progressive flexion contracture of the fingers. This means the fingers remain in an increasingly bent position, and fully straightening them becomes difficult or impossible. The disease most often affects the fourth and fifth fingers.

As the contracture progresses, the limited range of motion can affect hand function and make it difficult to perform daily tasks.

When is surgery for Dupuytren's contracture considered?

Surgery is considered when the fibrous cords cause progressive contracture and limit the ability to straighten the fingers. The goal of surgical treatment is to remove the pathological tissues and correct the contracture, restoring the fingers to as normal a position as possible.

The decision to perform the procedure is made by the surgeon after assessing the severity of the disease, finger mobility, and the patient's general health. During the consultation, the doctor will also discuss the surgical plan.

What does Dupuytren's contracture surgery involve?

The surgery involves excising the pathological fibrous cords responsible for the contracture. Once they are removed, the surgeon corrects the position of the affected fingers to improve their ability to straighten.

The procedure is usually performed under regional anesthesia, using a brachial plexus block. This allows the operated limb to be numbed.

A pressure cuff is placed on the arm so that the surgery can be performed in a bloodless field. This facilitates access to the affected tissues and allows for a precise procedure.

After the surgery, a thin drain is left in the wound. It is removed the following day during the dressing change.

How to prepare for Dupuytren's contracture surgery?

The first stage of preparation is a consultation with a surgeon. The doctor assesses the severity of the disease, the extent of finger movement restriction, and the patient's general health. Based on this, they will present a surgical treatment plan.

Next, the doctor will order the tests necessary for anesthesia. The scope of these tests is determined during the surgical qualification process.

Before the procedure, it is necessary to discontinue any medications that affect blood clotting. However, the method and timing for adjusting your medication must always be determined by your doctor. Do not stop taking prescribed medications on your own. During your consultation, you must provide full information about all medications you are currently taking.

In the preoperative period, you must also stop using any nicotine-containing products. Jewelry must be removed from the hand being operated on. It is also recommended to remove artificial nails.

Recovery after Dupuytren's contracture surgery

Immediately after the procedure, the operated hand is secured with a dressing and immobilized in a plaster splint. Restricting wrist and finger movement during the initial postoperative period promotes proper healing of the operated tissues.

An important element of post-operative care is elevating the hand, i.e., keeping it at approximately heart level. A sling helps with this. Positioning the limb in this way limits the development of post-operative swelling.

The drain left in the wound is removed the next day during a dressing change. Stitches are usually removed after about 14 days, while complete wound healing usually occurs after about 3 weeks.

However, the return of function does not end with the healing of the wound. Finger mobility should be regained gradually, in accordance with the doctor's recommendations and the rehabilitation plan.

Post-operative rehabilitation

Rehabilitation is a very important element of post-operative care for Dupuytren's contracture. It includes gradually introduced movement exercises and work on scar flexibility.

Exercises should be performed regularly and in accordance with the instructions received. Their scope and intensity should be adjusted to the healing stage and the current capabilities of the operated hand.

Full recovery of finger function and mobility is an individual process. The rate of improvement depends, among other things, on the stage of the disease before surgery and the patient's commitment to performing the recommended exercises.

What results can be expected after surgery?

The goal of the procedure is to remove pathological fibrous cords, correct the contracture, and improve the ability to straighten the fingers. This can make daily activities easier and increase hand function.

The extent of improvement achieved is individual. It depends primarily on the stage of the disease before surgery, as well as the healing process and systematic rehabilitation.

The final assessment of hand mobility must wait until the healing and rehabilitation process is complete. The healing of the wound itself does not mean full recovery of finger function.

Scar after Dupuytren's contracture surgery

After the procedure, a scar remains on the operated area of the hand. Once the wound has healed, working on its flexibility is important and forms part of postoperative rehabilitation.

Scar management should be adapted to the healing stage. Exercises and work on tissue flexibility can be started according to the doctor's recommendations. Do not massage an unhealed wound intensively on your own.

Contraindications for Dupuytren's contracture surgery

The procedure is contraindicated in the case of:

• active skin infection in the area of the hand being operated on,
• uncontrolled chronic diseases, such as diabetes or hypertension,
• blood clotting disorders.

Final qualification for surgery takes place during a consultation. The doctor considers the stage of the disease, the condition of the hand being operated on, the results of ordered tests, and the patient's overall health.