Hand surgery for Dupuytren’s contracture

Dupuytren’s contracture is a progressive condition that gets worse gradually over several years. It normally develops as follows:

• Small, lumps of firm tissue (nodules) form under the skin of the palm. They may be tender at first, but this usually stops as the condition progresses
• The nodules tighten and contract, forming thick bands of tissue
• Pitting (deep dents) appear on the surface of the palm as the diseased tissue pulls over the skin
• Thick cords of tissue develop that pull the fingers forwards, reducing flexibility and mobility in the hand

The exact cause of Dupuytren’s contracture is not known. The condition usually affects people in middle and old age and is more common in men.

 You may be at a higher risk of developing Dupuytren’s contracture if you:

• Have a family history of the disease
• Are of Northern European descent
• Take medication to control seizures
• Smoke
• Drink excessive amounts of alcohol
• Have a medical condition such as diabetes, thyroid disease, high cholesterol, or liver disease
• Have had a previous hand injury or surgery
• Have a low body mass index (BMI)

At your first consultation, you will be seen by a consultant orthopaedic surgeon, or hand surgeon. This is the doctor that specialises in your condition and will be responsible for your care.

Your consultant will ask you some questions about your health and symptoms. These may include:

• Your age
• Your medical history
• Your family history
• Your general health
• Any medications you are taking
• Your symptoms
• Whether you have had a previous hand injury or surgery

Your consultant will examine your hand and fingers. They will test the flexibility, and check for feeling (sensation) in your thumb and fingers. They may test your strength when you grip or pinch objects, check your range of motion and ask you to put your palm down flat on the surface of a table. Your consultant will check the size and location of any nodules or bands in your palm and measure the degree of contraction in your fingers. This is so that they can monitor the progression of the disease.

How is a diagnosis made?

Dupuytren’s contracture is diagnosed based on your symptoms and physical examination.

Why is this first consultation so important?

At Circle Health Group, your first appointment is very important, as it’s where your consultant will ask you about your symptoms, perform a physical examination, provide a diagnosis, and discuss possible treatment options.

Your first consultation is also where we get to know you and give you the opportunity to discuss your condition and ask your consultant any questions you may have. It is important to us that you are as well-informed and comfortable as possible before, during, and after your treatment, so discuss any questions or concerns with your consultant during your appointment.

After making a diagnosis, your consultant will discuss possible treatment options with you and decide on the best option based on your symptoms, diagnosis, general health, lifestyle, and expectations for treatment.

Your consultant will tell you everything you need to do to prepare for your surgery. If there’s anything you’re not sure about, or if you have any questions about how to prepare for your surgery, speak to your consultant or call the hospital for advice. Being well-prepared for your surgery will help to ease any anxiety you may have, as well as allow your surgery and recovery to go more smoothly.

Before your surgery, tell your consultant about any medical conditions or allergies you have, and any medication, including over-the-counter medicines you are taking.

Your consultant may tell you to stop taking some medications like blood thinners before your operation. This is to reduce the risk of bleeding during and after your surgery.

If you are having a general anaesthetic, you will not be able to eat or drink anything from midnight on the day of your operation.

What lifestyle changes can I make before my surgery?

Being in optimal health before your surgery can reduce the risk of complications and speed up your recovery.

To make sure you are as healthy as possible before your surgery:

• Eat a healthy, balanced diet with plenty of fruit, vegetables, lean proteins, and whole grains
• If you smoke, try to stop at least eight weeks before your surgery
• Avoid alcohol for a few days before and after your surgery. Alcohol thins the blood and can increase the risk of bleeding
• Take regular exercise

Do I need to prepare my home for after my surgery?

You will probably have some pain and stiffness in your hand for a few weeks after your surgery. If possible, ask someone to help with household tasks like shopping, cooking, and cleaning during your recovery. Stock up on easy to prepare food and prepare meals in advance that you can heat up during your recovery.

Surgery for Dupuytren’s contracture involves an operation called a fasciectomy to remove the diseased fascia. There are various techniques involved in fasciectomy surgery. Your surgeon will discuss the options with you and decide which type of surgery is most suitable for you based on the type and severity of your condition. It is important to remember that surgery does not cure Dupuytren’s disease, and the contractures can come back. This is known as a recurrence and can affect the same part of the hand or come back in a different place.

Needle fasciectomy

During a needle fasciectomy, a needle is inserted into the bands of tissue along your finger and palm. The tightened tissue is loosened and snapped, releasing your fingers, and allowing you to straighten them. This type of surgery is only suitable if your contractures are clearly visible beneath the skin of your palm. Needle fasciectomy is performed under local anaesthetic and takes around thirty minutes. You can normally go home on the same day.

Fasciectomy

A fasciectomy is a type of open surgery where incisions (cuts) are made in the hand and the diseased tissue is removed. It may be carried out under local or general anaesthetic. A fasciectomy normally takes between thirty minutes and 2 hours.

Dermofasciectomy

This operation is the same as a fasciectomy, but in addition to the fascia, some of the skin is removed from your palm or fingers. The skin is replaced with skin grafts taken from other parts of your body (normally the forearm). This procedure is commonly performed on people under the age of 40 who have had a previous fasciectomy, or if the skin is affected by the contracture.

Recovery from any type of surgery is different for everyone, and depends on factors such as your age, general health and whether or not there are complications during your surgery or recovery.

Your consultant will be able to give you an estimated recovery timeline based on your individual circumstances.

After your surgery, you will be taken to the recovery room where you will be monitored closely until the effects of the anaesthetic have worn off.

You will have a dressing and bulky bandage on your hand, and your hand will be elevated to help reduce swelling.

How many nights will I need to stay in hospital?

Hand surgery for Dupuytren’s contracture is normally done as a day case, meaning you’ll be able to go home later the same day. In some cases, particularly if you have had a skin graft during your procedure, you may need to spend one night in hospital. Talk to your consultant about how long you can expect to stay in hospital after your hand surgery.

Will I be able to drive home?

You will not be able to drive yourself home from hospital after your hand surgery. Please make arrangements for someone to come and collect you, or we can organise a taxi if you prefer.

How soon can I go back to work?

How soon you can go back to work after your surgery depends on what happened during your procedure, your individual recovery, and the type of job you do. If you use your hands a lot for work, you may need to take between 6 and 12 weeks off, but if your job does not require use of your hands, you may be able to return in 1 to 2 weeks.

Talk to your consultant about when you can expect to return to work after your hand surgery.

How soon can I drive?

You must not drive until your wound has healed and your stitches have been removed. This is normally around 2 weeks after your surgery. Check with your consultant and inform your insurance company before driving after your hand surgery.

When will I be back to normal?

Recovery from hand surgery is different for everyone and depends on several factors such as your age, general health, whether or not there were any complications, and the type of surgery you had.

You can expect your hand and fingers to be swollen for the first few days after your surgery. Elevating your hand and applying ice packs wrapped in a cloth can help with swelling. You may need to wear your arm in a sling for a few days after your procedure.

You will probably need to take painkillers for around the first week after your surgery. Your consultant can prescribe or recommend a suitable one. You may feel numbness or tingling around the incision site after your procedure. This usually subsides within a few days, but may last for a few weeks or even months.

Your healthcare team will give you an appointment to have your stitches removed around 2 weeks after your surgery.

Most people are fully recovered, and able to return to normal activities by around 6 to 8 weeks after the procedure.

Physiotherapy

An important part of recovery from hand surgery for Dupuytren’s contracture is physiotherapy. Our expert team of physiotherapists can give you exercises to do at home to increase flexibility in your fingers. You may need to wear a hand splint for 6 to 12 weeks after surgery.

As with all types of surgery, hand surgery for Dupuytren’s contracture carries a small risk of complications. Your consultant will explain all the possible risks and complications before your surgery, and answer any questions you may have about your procedure. Being as well-informed as possible about what to expect from your surgery will help put your mind at rest and allow you to make an informed decision, so please ask any questions you may have.

Possible complications of any surgery include:

• Bleeding
• Infection
• Blood clots
• Adverse reactions to the anaesthetic

Possible complications specific to hand surgery for Dupuytren’s contracture include:

• The surgery may be unsuccessful in correcting the contracture
• Damage to the small blood vessels in the finger
• Nerve damage
• Skin tears
• Scarring
• Stiffness in the finger joints
• Poor wound healing
• Wound infection
• Complex regional pain syndrome (CRPS)

At Circle Health Group, we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group, you can expect the highest standards of care, including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about hand surgery for Dupuytren’s contracture, book your appointment online today or call a member of our team directly.

Content reviewed by Circle in-house team in January 2023. Next review due January 2027.

• Dupuytren’s disease British Society for Surgery of the Hand
• Dupuytren Contracture National Library of Medicine
• Making a decision about: Dupuytren’s contracture NHS
• Dupuytren’s Contracture John Hopkins Medicine