The operation of a Dupuytren’s disease | What is Dupuytren’s disease?

The operation of a Dupuytren’s disease

An operation for Dupuytren’s disease leads to the best therapeutic success in the long term. Various surgical techniques can be used. A basic distinction is made between incision and excision.

Depending on the severity of the disease, the finger joints must also be treated surgically and contractures must be removed. Post-operative follow-up treatment is particularly important and has a major influence on the long-term success of the therapy. It consists of immobilization of the hand and specific physiotherapeutic exercises and should be started about three to five days after the operation.

The exercises restore the flexibility and mobility of the hand and prevent renewed scar contractures. The subsequent scar care is also important to keep the scars supple and prevent them from re-hardening. For more detailed information, please refer to our topic: Surgery of a M. Dupuytren’s

  • During the incision, the connective tissue strands that have formed in the palm of the hand and that have led to the contractures of the fingers are incised, which again causes the fingers to be stretched.

    To prevent a renewed contracture after the operation, the incision is made in zigzag lines (so-called Z-plasty).

  • In the excision procedures, parts or even the entire connective tissue plate of the palm is removed. One option underneath is dermofascicectomy. In this procedure, the affected area of the connective tissue plate and the shortened skin above it are removed.

    Since this results in a large tissue defect in the palm, a skin graft is subsequently inserted there. The most commonly used procedure is partial aponeurectomy. This involves the removal of all affected tissue from the palm and fingers.

    In partial fasciotomy, however, only parts of the hardened aponeurosis are removed. In the further course of the disease, recurrences are more frequent than if the entire fascia was removed. The most radical procedure is the complete aponeurectomy.

    In this procedure, both affected and unaffected fascial tissue is removed from the palm and fingers. This should reduce the risk of recurrence postoperatively. For a long time, this method was considered the procedure of choice, but today it is only preferred when the disease is severe.

    Due to the radical nature of the procedure, complications occur more frequently, which are observed much less frequently in partial aponeurectomy.

The duration of healing after surgery for Dupuytren’s disease can vary. A quick start with physiotherapeutic exercises has a positive effect on the course of the disease and helps the patient to regain the strength of the hand quickly. Most patients can return to work after six weeks.

Nevertheless, complete recovery typically takes a few months. After an operation, the operated hand must be fixed in place with a splint for five days. During this time, the hand must be completely spared, after which an early start with physiotherapy is recommended. There are various surgical options and the healing time varies from person to person. Nevertheless, most patients are able to resume work about six weeks after the operation.