Dupuytren’s contracture is a disorder of the interfacing of the palm deep to the skin of the hand. Thick nodules and scar like tissue forms in the area typically over the ring and little fingers. This can result in deformity, pain and functional inability to straighten the involved fingers. When the condition worsens to the point of restricting movement in the hand, surgical release is necessary.
Surgery is the only treatment for Dupuytren’s contracture when it becomes advanced. The surgery involves cutting the bands of thickened tissue, freeing the tendons and allowing better finger movement. The operation must be done precisely, since the nerves that supply the hand and fingers are often bound up in the abnormal tissue. In some cases, skin grafts are needed to replace the tightened and puckered skin, though skin expansion with zig-zag closure is often sufficient.
The results of the surgery will depend on the severity of the condition. You can usually expect full return of function, particularly after physiotherapy and splint wear. Scar management is carried out during the healing phase with silicone gel and massage. Risks include skin wound separation, bleeding and infection, rarely. Reasonable rates of recurrence are 40 % at 20 years.
Following Your Treatment
Since the hand is a very sensitive part, you may require pain medication post operatively. Tylenol # 3 is usually sufficient. However, there is occasionally need for stronger medication as well as long acting anaesthetic at the time of the surgery. Your hand must remain immobilized for approximately one week. After which the sutures are removed and the physiotherapy is initiated. Your therapy may involve hand exercises, heat, massage, electrical nerve stimulation, splinting, traction, and special wrappings to control swelling. Keep in mind that surgery is just the foundation for recovery. It’s crucial that that you follow the therapists instructions and complete the entire course of therapy if you want to regain the maximum use of your hand.
Post Op Instructions
THE DAY OF SURGERY:
-Please shower or bathe that morning. -Wear comfortable clothing/shoes that can be easily removed and put on such as pullovers, hoodies and pull on pants.
-The first 2-3 days post surgery is the most difficult. Relax. Rest. You will need help with day-to-day household activities (cooking, cleaning). If it hurts, you should not do it. Avoid bending and lifting. If you have had surgery that day don’t dangle the hand below your waist for 24 H, sleep with your hand slightly elevated. A travel pillow works well.
-Take your prescribed pain medication. Do not combine alcohol with your pain medication. However, if you develop excess pain, swelling or bleeding, go to the nearest hospital emergency department.
-There may be some discomfort and oozing from the site. This is normal. Keep the dressing dry and intact until you are instructed to remove it or Physio takes it off one week post op -Vigorous physical activity (jogging, bending and lifting) should be avoided for a minimum of 2 weeks after surgery. Limit exposure to high heat or sun.
Follow up is usually within 7-10 days post op. You should call the office at 204 231 1542 for your appointment time. If Dr Dolynchuk deems Physiotherapy necessary they will contact you after surgery on or around day 5.
Risks of Dupuytren’s Contracture Surgery
All surgery and medical procedures carry some degree of risks and/or complications. It is important that you understand that complications are a part of the post surgical process. The majority of our patients do not experience any complications. However, a small minority may. We do our very best to avoid any complications but if they do occur we do our best to treat them as soon as possible.
Bleeding/Hematoma- It is possible, though unusual to have a bleeding episode after surgery. Should it occur, apply pressure for 3 minutes and go the hospital emergency department. A hematoma appears as a lump and is painful. It has to be drained, go the hospital emergency department.
Infection- Infection in the surgical sites is possible. If there is redness, pain swelling, foul smelling pus/discharge or you have an oral temperature over 100.4 degrees Fahrenheit contact the office. Antibiotics or additional surgery may be necessary.
Scars- All surgical procedures produce a scar. Scars range from almost an invisible line to a thick ropey one. We cannot predict who will form unsightly scars. Scars initially may be a bright red color and then tend to fade over time.
Change in Skin Sensation- Sometimes an area may experience numbness or tingling. This may be temporary but it can also be permanent.
Delayed Healing- Wound separating or delayed wound healing is possible. It can depend on many factors such as: quality of skin, general health and dressing care. There can be skin loss and further surgery to remove the non-healed tissue.
Smoking- After your surgery it is important not to smoke (minimum 6 weeks) so the tissues heal properly. Smoking has been shown to increase post surgical complications and delay healing.
Pain- There may be some additional discomfort caused by swelling and bandages. We want you to be as comfortable as possible after surgery. Use Tylenol only for pain in the first 24 hours, then Advil for pain may be used after this.
Allergic Reactions- In rare cases patients may experience local allergies to tape, sutures or topical preparations. Please inform us prior to surgery if you have any allergies (ex. Latex, Aloe Vera, etc.). Patients may also experience allergies from anaesthetics (ex. lidocaine) and topical antibiotics like Polysporin®.