Synonyms
Dupuytren’s contracture; fibromatosis of the palmar fascia, Dupuytren’s ́sche Disease
- A fasciotomy
- A partial fasciotomy
- A total removal of the palmar aponeurosis
- Which form of therapy is considered in detail is individually different and depends on different aspects. A simple fasciotomy, for example, is usually only performed when a patient is in poor general condition or is very old, due to its relatively high probability of recurrence (recurrence of the disease pattern).
What forms of anesthesia are required for the procedure? As a rule, in order to keep the risk of anesthesia as low as possible, the surgical procedure for Dupuytren’s contracture is performed in the form of a so-called plexus anesthesia.
In contrast to general anesthesia, only the affected arm is anesthetized by the anesthetist injecting an anesthetic agent in the armpit area. About half an hour after the injection, the arm is anaesthetized so that the operation can begin. Since the patient is “fully” conscious during plexus anesthesia and not everyone wants to experience the operation, the patient can be additionally injected with a sleeping pill.
Another positive aspect is that the patient can eat and drink again immediately – if his health condition allows it. The anaesthetic as such gradually disappears. Thus the first pains that may occur are covered by the plexus anaesthesia and only rarely does an additional painkiller have to be administered.
In the last lines of the previous section it has already been indicated that cooperation during the post-treatment plays a major role. The first post-operative treatment is started immediately after the operation. Thus, the operated hand is immobilized with a plaster splint in the first week after the operation.
It is important that the fingers can move freely in all joints. A compression bandage is then usually applied to the plaster splint to prevent swelling of the hand after the operation, but allow the fingers to move freely. While the stitches can be removed about 14 days after the operation, the bandages are usually removed only after the third postoperative week.
Individual wound healing processes may result in a longer dressing duration. Since every bandage should place great value on the mobility of the fingers, it is clear that the movement of the fingers will play a major role in the postoperative treatment. In consultation with the attending physician, each patient should move his or her fingers again without stress and as independently as possible.
If patients follow the doctor’s instructions and cooperate well during this treatment phase, no physiotherapeutic treatment is usually necessary. If the swellings described above occur in patients, lymphatic drainage may also be useful. Step by step, the hand should be brought back to the stresses of everyday life.
This is done slowly and without overloading the operated hand over a period of about six weeks. Extreme stress must be avoided over a period of about 12 weeks, so that you may have to neglect your sports activities for this period. What can the patient additionally contribute to the aftercare?
Rubbing the scar tissue with a fatty cream several times a day has proven effective. The scar tissue around the hand is very sensitive and can be soothed by rubbing it in, but also by lukewarm hand baths (five times a day for five minutes). Kammillosan or curd soap can be added to the lukewarm water.
If you decide on both forms, it is recommended to apply the cream after the hand bath until the full mobility of the hand is restored. Can the disease reappear after an operation? In general, there is a possibility of recurrence, especially in the area of the small finger (up to 50%).
Recurrence surgery is much more difficult, so that in the event of a relapse, only the treating physician can advise on further therapy. It is not possible to predict whether recurrences will occur before surgery. However, there are constellations that increase the probability of recurrence.If the following points apply to a patient individually or in their entirety, this still does not mean that a relapse will occur in any case.
It is only intended to illustrate that the probability of recurrence is then significantly increased. In principle, it is important to distinguish between a genuine new disease and a recurrence. One speaks of a recurrence of the disease if the same area is affected by the disease again.
On the other hand, a new disease is present if the Dupuytren’s contracture now relates to a different area of the hand: For example, if the little finger was first treated and now the middle finger is affected by Dupuytren’s disease ́sche One of the reasons why recurrences or new diseases occur is that a genetic disposition is assumed. This means that although the diseased tissue was removed during the operation, it is not possible to switch off a genetic component.
- Dupuytren’s disease runs in the family (genetic component)
- The disease has spread to other fingers (thumb and index finger).
- Other parts of the body are affected in a similar way (see above)
- The first disease was before the age of 40.
General risks are inherent in every operation, including the Morbus Dupuytren operation.
Not least for this reason, they are informed of the risks before the operation. In addition to the general risks, the attending physician can also address individual risks that are related to your illness or other health problems, for example. In general, there is no surgery without risk, but complications in connection with this operation are quite rare.
Infections can occur with every operation – even if it is very small. Infections can delay the healing process and may require further surgery. In medical terms, such an operation is called revision surgery.
In addition, in exceptional cases, wound healing can be impaired and, under certain circumstances, the mobility of the entire hand area can deteriorate. Since skin grafts are used during the operation for Dupuytren’s disease, circulatory disorders in the skin flaps can occur, thus prolonging the rehabilitation period. In some patients it may happen that the skin grafts do not grow into the new area or only partially.
It should also be mentioned here that although most of the above-mentioned complications put a strain on the healing time and process, the postoperative result does not have to be worsened. In most cases, good results are still achieved. If you look at your hand, you will notice already from the outside that there is “quite a lot in it”.
In addition to the possible complications mentioned above, injuries to nerves or blood vessels (larger branches of the vessels that supply the skin) cannot be ruled out. With experienced hand surgeons this occurs very rarely. In addition, there is now the possibility of reconstructing arteries or nerves by microsurgery, so that postoperatively, even in this case, impairments can rarely be assumed.
Disturbance of the fine blood circulation is also conceivable, as well as swelling in the operated area. The attending physician will be happy to inform you about further risks of the operation. Only he can assess your state of health beyond the general risks and possibly point out individual risks.
When should surgery not be performed for Dupuytren’s disease? Individual pre-existing conditions can prevent surgery. Depending on the general condition of the patient, the risk of an operation is too high.
For example, such operations should not be planned if: It is very important for the outcome of the operation that the patient himself/herself cooperates well and continuously in the post-operative phase. If this commitment is not present, it can also be a “contraindication”. You will see in the next section why the willingness to cooperate in the post-operative phase plays such an important role.
- The patient suffers from clinically recognizable circulatory disorders of the fingers.
- Untreated eczema or already infected wound(s) are found in the area to be operated on
- The hands are already swollen preoperatively.
- The patient suffers from serious general illnesses and therefore this and operation risk cannot be represented (e.g. a few months ago heart attack).
