In Dupoytren’s contracture, the surgery is almost always bloodless. Surgeons use a surgical tourniquet to prevent blood flow to the limb, so as to identify the anatomic structures of the hand more easily. We always opt for the least invasive surgical treatment yielding best results possible in improving hand function. One such procedure is faciotomy: a surgical cut is made into the thickened fascia to relieve the tension that has been causing the finger to bend into the palm. Unfortunately, with this procedure a satisfactory solution for the patient’s problems can only rarely be achieved. In most cases, an S-shaped incision is made into the skin covering the thickened fascia and the curled fingers. Thus, the surgeon can access the thickened connective tissue of the palm and finger(s). This abnormal tissue, which grows into deeper structures, especially the tendons, is the main reason for Dupuytren’s disease. The surgeon’s aim is to remove this tissue and make the tendons flexible again so that the affected finger(s) may be fully extended. The abnormal tissue may also contain other anatomical structures of the hand, especially nerves and veins. There is slight risk that neurovascular structures have been damaged due to changes in anatomy caused by the disease. Even though it is very unlikely, injury to neurovascular structures can cause poorer sensitivity of the operated-upon finger(s). Another issue concerns the skin covering the area affected by the Dupuytren’s disease, because the disease often changes the skin to such an extent that it needs to be removed during the operation. The surgical wound is closed by using healthy skin around the wound margin or a skin graft. After the surgery, the hand is wrapped in a compression bandage, which reduces blood flow to the wound. The other critical component of pain relief is elevation of the hand above the level of the heart, which allows gravity to diminish swelling. The patient is woken up in the operating room and transferred to a recovery room.
Owing to the side effects of anaesthesia, you will need to stay in hospital for a few hours. If necessary, you will be given painkillers, though the post-operative pain is relatively mild. The hand must remain elevated or rest on a pillow at all times. Before checking out, you will be examined by the surgeon and the anaesthesiologist so as to make sure that you are medically fit for discharge. You will be given oral and written aftercare instructions and the hand will be put in a sling. Please arrange to have someone drive you home or accompany you after checking out. Typically, a post-surgery check-up takes place the next day.