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When Should You Get Surgery for Dupuytren's Contracture?

January 12, 2021

If you’ve recently been diagnosed with Dupuytren’s Contracture, you’ll surely have asked your doctor what kind of treatments are available for the condition.

You might wonder about exercises, or topical creams, or other treatments. But one of the most common questions asked is when you should opt for surgery for your condition, and whether it’ll make any long-term difference.

What Causes Dupuytren’s Contracture?

Dupuytren’s occurs when there is a hardening of the fascia in the of the hand, which pulls fingers down towards the palm. Eventually, when the disease is advanced, the fingers will stick to the palm and it is impossible to voluntarily straighten them.

Doctors have spent many years investigating the root causes of Dupuytren’s Contracture and while they haven’t been able to definitively pinpoint the exact cause, it’s thought to be related to both genetics and lifestyle.

Diagnosis is swift and can be accomplished with a single visit to a doctor, without the need for further tests.

Is Everybody Affected by the Condition in the Same Way?

No, not at all.

For some patients the condition is mild and progresses slowly. They may begin to notice only a slight hardening of the palm of the hand and feel some numbness in the area that stretches up the fingers.

Other patients, however, report a much faster onset of symptoms from its initial stages, when they first begin to notice its appearance. The hardening of the fascia occurs quickly, and within a few months the patient’s fingers have been pulled down toward the palm so greatly that everyday operations become difficult.

Is Surgery the First Choice to Tackle Dupuytren’s Contracture?

Unless the symptoms of the condition are advanced by the time the patient first goes to a doctor for a consultation, it’s unlikely that surgery will be the first suggestion that a doctor will make.

This is because even when surgery is performed, the chance of the disease returning is moderately high, so doctors tend to wait until other options have been exhausted first.

As theMayo Clinic comments, when “fine motor activities such as writing” remain unaffected, patients choose to live with the disability much longer than they may do other conditions.

However, if your life is becoming severely impeded by the condition; for example, you cannot put on gloves or lift a glass of water safely, then there will be little choice but to refer you for a surgical consultation.

When Should Surgery for Dupuytren’s Contracture be Considered?

As we mentioned, surgery for Dupuytren’s is something that should be considered when all other options have failed to help. Whether you've tried exercising the hand, rubbing in creams or even enzyme injections, it may be that none of these have helped slow down the disease.

Dupuytren’s is a mostly completely painless disease, and for this reason many patients choose to put up with the inconvenience of their hands been affected, particularly when they are older and have other medical conditions, that they deem more pressing and urgent.

The surgery is considered elective, in that Dupuytren’s Contracture is not a life-threatening illness. Therefore, you may choose not to have any surgical intervention for several years and may change your mind at a later date if the condition has advanced to the stage where your life is severely impacted.

What Types of Surgery Will be Recommended?

There are several different surgical treatments that a surgeon may recommend when you present to him with Dupuytren’s Contracture. The decision that is made as to which treatment you opt for will mostly depend 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, but other procedures can be performed under local anesthetic, and you will be sent home the very same day.

The main types of surgery for Dupuytren’s that are most commonly offered 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 completed. Once the fascia is removed, the wound is either stitched up or left to heal naturally.
  • Dermofasciectomy – Similar to a fasciectomy, this procedure involves removal of the fascia, but also of the skin of the palm, too. It’s a more complex procedure and is recommended for those patients who have advanced symptoms of the disease.

When the skin of the palm is removed, it cannot be stitched or left to heal by itself, and so a skin graft is usually taken from the groin or upper arm area.

  • Fasciotomy – Rather than requiring a general anesthetic as the first two procedures do, this third option involves only a small incision, performed under local anesthetic.

In this procedure the fascia is removed more gradually through the small incision and is thought to be a better option for both milder cases, and for patients who, for whatever reason, should not undergo a general anesthetic.

The type of surgery that your surgeon will recommend will be discussed during your consultation, which is the best time to ask any of the questions you may 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 before your surgery to check that there are no underlying health issues that may impact the procedure.

Once the procedure has been completed, whether that’s under general or local anesthetic, the recovery time is thought to be fast. However, some patients have noted the following issues post-surgery:

  • Nerve Damage – One of the main risks to a patient with this kind of surgery is damage to the nerves. The hand is made up of around 17,000 different touch receptors and nerve endings and if any of these are damaged during the surgery, you may experience loss of sensation.
  • Scarring – As you may expect, particularly if you have had a skin graft, there will be a small scar in the palm of your hand, perhaps up to the fingers.
  • Recurrence – For many patients, the choice not to have surgery is made because Dupuytren’s can reoccur in over half of cases.
  • Bleeding and Infection – All surgical procedures carry the risk of bleeding and this can be swiftly managed. Any infections as a result of surgery will be treated with antibiotics.

What Other Treatments Can Help Alleviate Dupuytren’s Symptoms?

Doctors will more often than not try several different treatments before surgery becomes necessary. The important thing is to see you doctor as soon as you begin to notice signs of Dupuytren’s Contracture.

For instance, if you notice a hard bump or skin thickening in the palm of the hand, or you cannot lie your hand flat on the table, you may have Dupuytren’s.

Exercises to maintain movement in the fingers and hand are an effective way to keep the blood flowing and stopping the use of vibrating tools is also important, as those who use vibrating machinery are thought to be at particular risk of the disease.

Several patients have found that deep massage to the palm of the hand with the use of a cream such asDupuytrensco has greatly helped them. This all-natural cream helps to reduce inflammation in the hand and break down the scar tissue that pulls down the fingers.

Using this cream twice a day will not only help reduce inflammation but will also encourage blood flow to the area of the hand and fingers.

Enzyme injections to dissolve the cartilage of the fascia and loosen the bands around the tendons can be helpful, as can a process called needling, where a needle is inserted into the fascia and the cartilage broken apart to again loosen the constricting fibers.

Can Dupuytren’s Contracture be Prevented?

It's thought that the main determining factor of Dupuytren’s is genetics. It's more likely to be found in males over the age of 50, of Caucasian ethnicity, particularly those of Scandanavian descent.

However, doctors have found that there are definite links to lifestyle that affect its chance of both beginning and recurring.

Smokers, drinkers, and those on certain medications are at greater risk of developing the disease. As a result, if you have begun to show symptoms of Dupuytren’s Contracture or have received a diagnosis, cut down on your drinking and try to quit smoking completely to slow down progression of the disease.

An important factor in treating Dupuytren's Contracture effectively is, as is the case with many diseases, early detection and diagnosis.

Once you have been diagnosed, be sure to keep up with the exercises you have been given and to keep blood flowing to the area. Wearing gloves, especially in cold weather, is also important. 

However, if none of these make a difference to your condition and it is negatively impacting your life, then you may find that surgery is the only answer.

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