What happens during surgery of the affected hand?

The excrescent fascia (tissue within the palm) will be removed as well as possible by the hand surgeon.

The surgery takes about an hour in early stages of the disease.
In severe forms of the disease the skin in the palm has shrunk. In these cases an elongation of the skin is necessary. This is realised through a forming of the skin or a skin transplantation.
Furthermore the tendons and joints need special treatment due to their long disuse.
This is why surgery of severe forms of Morbus Dupuytren often requires several hours of operating time.

Generally speaking, surgery of a severe stage of Morbus Dupuytren is possible.
Nevertheless surgery should be considered in a prior stage of Dupuytren's Disease. (25° stretching disability of a finger)

Severe form of Morbus Dupuytren

You shall never wait as long as shown on the picture above to take medical advice!

Result after 3 hours operating time

What causes problems when performing surgery in a severe stage of Morbus Dupuytren?

First of all, surgery of a Stage IV Dupuytren's Disease requires more operating time and bears a higher risk of complications.
Besides that you can not assume a complete recovery from the disability to fully extend the affected finger even after the surgery.
The aftercare also requires more time if surgery is performed in a severe stage of the disease.

What kind of narcosis do I need in case of a surgery?

We prefer local anaesthetics of the arm. Therefore the anaesthetist injects the anaesthetic in the patient's armpit (axillary). It takes 30 minutes until surgery can begin.
Local anaesthetics are a minor risk for the patient and have been approved in hand surgery for decades.
Another advantage for the patient is the ability to drink and eat instantly after the surgery.
Last but not least it is important to mention the fact that local anaesthetics last for hours after the surgery.
It is also possible to sleep during the surgery by means of a barbiturate which is not a general anaesthetic.

What kind of risks may occur when treating Dupuytren's Disease with surgery?

I will only present some general risks. For an individual evaluation of your risk please take medical advice.

There is no surgery without risk!
Nevertheless the great majority of patients suffering from Morbus Dupuytren endure surgery without complications and feel relief from the ailment.

Nevertheless the following complications may occur and decrease the healing process:

• a dysfunction of the wound healing

  • risk increases if skin transplantation is required

• the agility of the affected hand may decrease

• surgery always contains the risk of an infection of the wound which could lead to an additional surgery

The following complications are rare but severe:

• nerves or blood vessels may receive an injury during surgery

  • This is a severe complication that is very rare in a specialised department for hand surgery.
    Every specialised hand surgeon is capable of reconstructing injured nerves or blood vessels by means of microsurgery.
    Nevertheless a neurological deficit may last.

• dysfunction of the capillary blood circulation of the hand (Morbus Sudeck)

  • This complication may cause immobility of the hand, pain and swelling.

  • In extremely rare cases the ailment may lead to a necrosis of a finger. I have not observed this complication after performing over 3000 surgeries of Dupuytren's Disease.

I take blood diluting medicine, does this affect surgery?

Many people take blood diluting medicine for various reasons. Best known are Aspirin, ASS100, Markumar and Plavix.

These drugs shall not been taken 10 to 12 days before the surgery of the hand.
Never quit a medication without consulting your attending physician!
It may be necessary to receive injections of Heparin to replace your usual blood diluting medicine.

What is meant by open hand therapy?

The open hand therapy was introduced to hand surgery by McCash.
The surgeon does not completely close the wound after the surgery, some areas of the finger or hand are left open. This form of therapy lowers the risk of an effusion, swelling of the hand and pain.
Nevertheless, the aftercare takes more time for the open hand therapy. The healing of the open skin areas takes approximately 3 to 5 weeks.
We choose this form of therapy in severe stages of Morbus Dupuytren or if an second surgery is required.

What are reasons against surgery of Dupuytren's Contracture?

• dysfunction of the blood circulation in the fingers

• patient's inability to participate in the aftercare

• an exzema or open wound in the operating field

• oedema of the hand (rare)

• affection of the patient which enhances the risk of a narcosis (e.g. short time after a heart attack)

Is there a chance to perform surgery of Dupuytren's Disease on both hands simultaneously?

No! Generally speaking, a scheduled surgery will be performed only on one hand at a time.
The second hand receives surgical treatment after the healing process of the first hand is successfully completed.