Download Dupuytrens Fasciectomy - Gateshead Health NHS Foundation Trust

Dupuytrens Fasciectomy
A guide for patients
Gateshead Upper Limb Unit
Andreas Hinsche
John Harrison
Jagannath Chakravarthy
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What is Dupuytren’s Contracture?
Dupuytren’s contracture is a condition that affects the hands and fingers. It causes one or
more of the fingers (on one or both hands) to bend into the palm of the hand. This is not a
condition affecting the tendons (guides that allow us to bend and straighten our fingers)
How common is Dupuytren's contracture?
Dupuytren's contracture is a fairly common condition. It tends to affect more men than
women, and often occurs in later life. It can affect up to 20% of men above 60, and 20% of
women who are over 80 years old.
Dupuytren's contracture is most commonly found in white Europeans, and it is believed to run
in families.
What do we know about it?
Research has failed to reveal the exact cause of this condition but we know that
It is benign ( ie not cancerous)
It can run in families
It is commoner in diabetics/ smokers/ people on certain anti-epileptic medications and
people using vibration tools
It is more aggressive if it affects both hands or the thumb and index finger. Also if it
affects young patients.
It is a progressive condition. If one or more fingers become permanently bent, it can
make daily activities, such as buttoning up a shirt, difficult.
There is no cure
What are the symptoms
It is usually a painless condition though it can be painful in the initial stages
It starts off as nodules (small growths or lumps of tissue) that appear in the palm. One might
find the skin to be pitted ( like dimples) around the nodule. Over time, the nodules can grow
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into cords of contracted (shortened) tissue. As the tissue contracts, it becomes difficult to fully
straighten the finger, which eventually becomes permanently fixed in a flexed (bent) position.
What are the treatment options
The treatment depends on the severity of the deformity of the fingers
Leaving it alone and observation over time is best for patients with mild deformities,
isolated nodules and in patients with minimal functional limitation.
Needle / Percutaneous fasciotomy is occasionally indicated for patients with
isolated deformity of the knuckle joint. It involves using a needle or knife to snap the
band causing the deformity. This is usually done under local anaesthetic. Recurrence
rates are high
Fasciectomy involves removing all visible dupuytren’s tissue . This requires a fairly
long incision over the palm. This has the least recurrence rates.
Injections are a new treatment which are not yet available in the trust as it is still
experimental. The injection has a drug which weakens the band which is then
snapped straight in the outpatient clinic
Why do I need an operation?
The main reason why surgery is necessary is to prevent further flexion (bending) of the
affected fingers as this will restrict the function of your hand. The flexion deformity not only
becomes a nuisance but can be dangerous in some occupations or activities.
If the deformity is not corrected early enough then successful release is less likely and in
some cases amputation of the affected fingers is the only alternative.
What does the operation involve?
The operation consists of having an anaesthetic, usually a general anaesthetic, that puts you
to sleep, but on occasions a “nerve block” which “numbs” the affected arm is used as an
alternative. The procedure involves removal of the tight tissue band/s causing the deformity.
You will have one or more incisions in your hand, these wounds are usually stitched in a zigzag manner. In some cases a skin graft may be required, where a patch of
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skin from the forearm or wrist is grafted into the scar. During the first three days after surgery
it is normal to have a bulky dressing in place (like below) and a high sling to reduce the risk of
bleeding or swelling.
What happens before the operation?
Prior to admission you may need to have a pre-operative assessment. This is an assessment
of your health to make sure you are fully prepared for your admission, treatment and
discharge. Before the date of your admission please, read very closely, the instructions given
to you. If you are undergoing a general anaesthetic you will be given specific instructions
about when to stop eating and drinking, please follow these carefully as otherwise this may
pose an anaesthetic risk and we may have to cancel your surgery. You should bath or
shower before coming to hospital. Please trim your nails and keep your hands clean.
Remove any rings your might have on the operation side.
The surgeon and anaesthetist will visit you and answer any questions that you have. You will
be asked to sign a consent form. A cuff will be put on your arm, some leads placed on your
chest, and a clip attached to your finger. This will allow the anaesthetist to check your heart
rate, blood pressure and oxygen levels during the operation. A needle will be put into the
back of your hand to give you the drugs to send you to sleep.
How long will I be in hospital?
You may be admitted as a day patient, when you will be able to go home shortly after the
operation. Alternatively you maybe admitted to the ward, either on the day of your operation
or the day before. You are usually ready to go home within 24 hours following your surgery.
If you are an in-patient you may be seen by the physiotherapist and you may be given
exercises within your bandage. It will also be necessary for you to attend the hospital for
outpatient physiotherapy once your stitches have been removed.
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What complications can occur?
This leaflet describes only the more common or serious complications.
Infection is always a possibility following any surgical procedure, therefore it is very
important to keep the dressings clean and dry. Infections are easily treated with
antibiotics.If you feel your dressing needs changing please contact the hospital via the
numbers on the back of this leaflet.
Bleeding from the wound may also occur and to minimise this it is therefore important
to keep the hand elevated during the first 48-72 hours following your surgery.
Nerve damage can occur because the nerves of the hand may be entwined around
the cord. It is quite common to have some numbness or tingling in the finger for upto
six weeks. The risk of nerve damage resulting in alteration or loss of some sensations
to the fingers, this is a rare complication.
Recurrence rates are 50% over 10 years on average. Most recurrences do not
require surgery.
What symptoms may I experience after my operation?
After surgery you may experience stiffness and scar tenderness. With time and gentle use
the stiffness should disappear, this is usually over 6 weeks to 3 months. The scar will remain
pink for some time and gradually fade to a white line. There may be some discomfort and/or
pain following surgery to the wrist but this can usually be controlled by simple painkillers.
However, if your pain is severe and continuous you should contact your GP.
Will I need Physiotherapy?
You will be seen by the Physiotherapist after your surgery, either on the ward or shortly after
your first out-patient appointment. Sometimes you may be seen when your dressing is first
removed after surgery. Gentle finger movements may be commenced if your wound is
satisfactory. A night splint will be required for 3 months.
You will be seen again following removal of your stitches and physiotherapy appointments
will be arranged. You will attend once or twice a week initially, when treatment will consist of
exercises and scar management.. The timing of different treatments will depend on how
quickly your wound heals, it is possible you may still require dressings even when you are
receiving physiotherapy treatment. You will be advised when the wound is sufficiently healed
to allow washing. Scar massage will be taught at this stage.
When can I resume normal activities?
Normal light use of the hand is encouraged once the wound is healed. Heavy and repetitive
use should gradually be reintroduced. Be guided by your pain and any swelling in your hand.
Driving
Generally you are safe to drive when your wound is healed and you are free of your
dressings, providing you have a good range of bend in the fingers and your hand is not too
painful and tender.
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Washing-up
This should be avoided until the wound is healed, you may need to use a rubber glove
initially as your hand may be a little sensitive to the heat of the water.
Work
Your return to work will be dependent on your recovery following surgery and the nature of
your job. Most people return to work within 6-8 weeks although this may vary depending on
your job, side of dominance, any complications and the rate of recovery of hand function.
This should be discussed with your Consultant.
Swimming
If you are going on holiday then avoid swimming, especially in the sea, until the wound is fully
healed.
Where can I get further information?
Your Consultant and GP will be able to answer most of your questions, as will the
Orthopaedic Nurse Practitioners who will see you prior to your admission.
Telephone numbers
During the hours of 8am -8pm contact the Day Surgery Unit,
North East NHS Surgery Centre, Queen Elizabeth Hospital
0191 4453009
During the hours of 8pm -8am contact Level 1, North East
NHS Surgery Centre, Queen Elizabeth Hospital
0191 4453005
During the hours of 0800 -1630 contact the Physiotherapy
Department (please ask for a member of the upper limb team)
0191 4452320
Main switchboard
0191 4820000
Data Protection
Any personal information is kept confidential. There may be occasions where your
information needs to shared with other care professionals to ensure you receive the best care
possible. In order to assist us improve the services available your information may be used
for clinical audit, research, teaching and anonymised for National NHS Reviews. Further
information is available in the leaflet Disclosure of Confidential Information IL137, via
Gateshead Health NHS Foundation Trust website or the PALS Service
Information Leaflet:
Version:
Title:
First Published:
Last Reviewed:
Review Date:
Author:
NoIL279
3
Dupuytrens Fasciectomy
June 2010
November 2012
November 2014
Gateshead Upper Limb Team
This leaflet can be made available in other languages and
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formats upon request