Dupuytren's Disease: Surgery

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Surgery

Surgery is the main treatment option for severe cases of Dupuytren's disease. The goal of surgery is to restore the use of your fingers and hand. In most cases, surgery removes the diseased soft-tissue bands that connect your finger joints to the palm, and may involve a skin graft. Total hand function may not be completely restored by surgery. Even with successful surgery, thickened palm tissue may develop again in the same place or in a new area of the hands. Reoperation is often necessary to keep hand function.

You may improve the outcome if you do postsurgical rehabilitation with finger exercises and splints, as directed by your health professional.

Should I have surgery for Dupuytren's disease?

Surgery Choices

Depending on your condition, your surgeon will choose one of the following surgical procedures:⁵

• Fasciectomy. Removal of the affected tissue (fascia) is the most common procedure.
• Fasciotomy. The tight cords in the palm are divided through small incisions. This procedure is used for people who cannot have more extensive surgery or general anesthesia.
• Amputation. Removal of one or more fingers is rarely needed but may be done if earlier procedures have resulted in nerve or vessel damage or the disease has recurred repeatedly.

In rare cases, the middle joint of the finger is fused (permanently joined) to keep it from bending in.

What To Think About

When you are deciding about surgery, think about:

• The presence of any other health conditions or diseases, such as diabetes.
• Your willingness to go through postsurgery rehabilitation, which is necessary in order to restore hand function.
• The severity of the loss of hand function and how you are affected in your daily activities.
• Your age. The risk of complications and treatment failure are greater with advanced age.

Needle aponeurotomy is a form of fasciotomy that is done as an outpatient procedure with local anesthesia. It has been done for several years in France, but it is just being introduced in the United States. This procedure may be good for people who cannot have surgery, or as a way to delay surgery. But it only partially corrects pulling or contracture between the fingers and the palm. Also, there is chance of damaging nerves of the adjacent fingers, and there is a high chance the contracture will come back.

Last updated:	March 31, 2008
Author:	Shannon Erstad, MBA/MPH
Reviewed By:	William M. Green, MD - Emergency Medicine, David Pichora, MD, FRCSC - Orthopedic Surgery
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC