When Should You Get Surgery for Dupuytren's Contracture?

If you’ve recently been diagnosed with Dupuytren’s Contracture, you likely have asked your doctor what kind of treatments are available. You might wonder about exercises, topical creams, or other treatments that you've heard about. But some of the most common questions asked are, "When should I have surgery for my condition?" and "Will surgery give me long-term relief?"

Is Surgery the First Choice for Dupuytren’s Contracture?

Unless your symptoms are advanced at the time of your consultation, it’s unlikely that your doctor will immediately recommend surgery. This is because, even when surgery is performed, the chance of the disease returning is relatively high. So doctors usually wait until other options have been exhausted first. According to the Mayo Clinic, when a person's ability to perform fine motor skills such as writing are unaffected, patients typically choose to live with the disability much longer than they may do with other conditions.

However, if your life is becoming severely impacted by the condition (for example, if you cannot put on gloves or lift a glass of water safely), then there is a much greater chance that you will be referred to a surgeon for further examination.

When Should a Doctor Recommend Surgery for Dupuytren’s?

As we mentioned, surgery for Dupuytren’s should be considered when all other options have failed. Dupuytren’s is a mostly painless disease, so many patients choose to put up with the inconvenience of hand deformities. This is usually the case for older adults who have other medical conditions that they view as more serious and concerning.

Dupuytren's surgeries are considered elective because Dupuytren’s is not a life-threatening illness. Therefore, you may choose not to have any surgery for several years, but you may change your mind later if the condition has advanced to severely impact your life.

What Types of Surgery Are Recommended?

There are several different surgical treatments that a surgeon may recommend when you present with symptoms of Dupuytren’s Contracture. The decision is made based on how advanced the condition has become.

Some surgeries will require a general anesthetic, where you will be unconscious for the surgery and will need to stay in hospital overnight. Yet other procedures can be performed under local anesthetic, which involves numbing the area that is operated on. For the latter surgery, you are sent home the same day. The main types of surgery for Dupuytren’s are:

• Fasciectomy – This is when the hardened fascia in the palm of the hand, which is usually the first symptom of the condition, is removed completely. Once the fascia is removed, the wound is either stitched up or left open so it can heal naturally.
• Dermofasciectomy – Similar to a fasciectomy, this procedure involves removal of the fascia, but also of the skin of the palm. It’s a more complex procedure and is recommended for patients who have advanced symptoms. When the skin of the palm is removed, it cannot be stitched or left to heal by itself, so a skin graft is usually taken from the groin or upper arm area.

• Fasciotomy – This third option does not require a general anesthetic as the first two procedures do. Rather, doctors only make a small incision under local anesthetic to gradually remove some tissue. This is a better option for mild cases of Dupuytren's.

Your surgeon will discuss the type of surgery they recommend during the consultation and this is a good time to ask any questions you might have.

Are there Risks Involved with Surgery for Dupuytren’s Contracture?

There are always risks involved with any surgery that involves a general anesthetic. But you will receive a full medical evaluation before your surgery to check that there are no underlying health issues that may impact the process.

Once the procedure has been completed, the recovery time is relatively short. However, some patients have noted the following issues post-surgery:

• Nerve Damage – One of the main risks is damage to the nerves. The hand is made up of around 17,000 nerve endings. So if any of these are damaged during the surgery, you may experience loss of sensation.
• Scarring – As you may expect, there will be a small scar on the palm. This is usually more noticeable if you have had a skin graft, since the incision may extend up to the fingers.
• Recurrence – Many patients choose not to have these operations. This is because over half of people who have had Dupuytren’s surgery will experience a return of their symptoms.
• Bleeding and Infection – All surgical procedures carry the risk of bleeding, but this can usually be managed easily since the area operated on is quite small. Any infections that result from surgery are treated with antibiotics.

What Other Treatments Can Alleviate Dupuytren’s Symptoms?

Doctors often suggest that someone tries several different treatments before recommending surgery. It's most important to see your doctor as soon as you begin to notice signs of Dupuytren’s Contracture. Some of the most obvious signs are a hard bump on the palm, thickened skin on the hand, or the inability to lie the hand flat on a table.

Exercises to maintain movement in the fingers and hand are an effective way to keep blood flowing. Similarly, if you stop or minimize your use of vibrating tools such as jackhammers and hair clippers, you can help prevent symptoms since this places someone at risk for the condition.

Several patients have found that massaging all-natural contracture cream into the palm of the hand has greatly reduced their pain. Our all-natural cream helps reduce inflammation in the hand and break down scar tissue that pulls on the fingers. Using this cream twice a day will not only help reduce inflammation but it also encourages blood flow to the hand and fingers.

There is the possibility these latter options won't work, in which case you may need surgery. If any symptoms continue to negatively impact your life in a major way, you may find that surgery is the only answer.