Dupuytren's Fasciectomy
Locked fingers can be skilfully treated by Dr Oscar Brumby-Rendell.
Dupuytren’s (du-pwe-tranz) contracture is a progressive condition characterised by the thickening and tightening of the fascia beneath the skin of the palm and fingers. Dr Oscar Brumby-Rendell is and Adelaide-based orthopaedic surgeon specialising in treating upper limb and hand conditions, including Dupuytren’s contracture, and offers advanced surgical solutions to restore hand functionality.
Understanding Dupuytren’s Contracture
Dupuytren’s contracture is a hand condition where the fascia (a fibrous layer under the skin) in the palm thickens and tightens. This creates nodules and rope-like cords that gradually pull one or more fingers into a bent position. Early on, patients may notice small lumps or puckered skin on the palm.
Over time, the cords shorten and the affected fingers (often the ring and little fingers) progressively curl toward the palm, making it hard to straighten them. If untreated, severe contracture can permanently limit hand function and make routine tasks (like gripping or putting on gloves) difficult.
- The disorder often starts with painless nodules in the palm that grow into thickened cords of tissue.
- As these cords tighten, they pull the fingers inward (most commonly ring and pinky), limiting extension and hand mobility.
Receive expert diagnosis and compassionate care for Dupuytren’s contracture
Diagnosis of Dupuytren’s Contracture
Dupuytren’s is typically diagnosed very easily with a simple visual inspection of the hand! The cords and nodules are very characteristic and straight forward to diagnose for an experienced hand surgeon. A detailed medical history and discussion of symptoms are essential for managing Dupuytren’s contracture. This helps in understanding the severity and progression of the condition.
Dr Oscar Brumby-Rendell will then perform a physical examination, assessing the hand for nodules and cords, and evaluating finger mobility and grip strength.
Accurate diagnosis is critical to determine the most appropriate treatment plan, whether non-surgical or surgical, to manage Dupuytren’s contracture effectively.
Non-Surgical Treatments
- Corticosteroids: Corticosteroid injections can reduce inflammation and slow the progression of contracture by decreasing the size and hardness of the nodules.
- Gamma Interferon Treatment: This therapy targets the fibrous tissue in the palm, helping to soften and reduce the nodules.
- Calcium Channel Blockers: Medications like verapamil can be used topically or injected to reduce the development of fibrous tissues.
- Percutaneous Needle Fasciectomy: A minimally invasive procedure where a needle is used to cut the contracted cords in the palm, offering symptom relief without large incisions.
- Xiaflex Collagenase Injections: Xiaflex (collagenase clostridium histolyticum) is an enzyme injection that breaks down the collagen in the Dupuytren’s cords, effectively reducing contracture. It is particularly useful for isolated, primary central cords but has limitations:
- Medicare Coverage: Xiaflex injections are not covered by Medicare, which may affect affordability.
- Complex or Multiple Cords: This treatment is not suitable for complex cases or patients with multiple affected cords.
Surgical Treatments for Dupuytren’s Contracture
If Dupuytren’s contracture progresses to the point where it severely limits hand use, surgery is often recommended. Surgical options aim to remove or release the thickened tissue so fingers can straighten. The main surgery is a fasciectomy, where the surgeon cuts out the diseased fascia that is pulling the fingers in. This allows the fingers to relax back to a more normal position.
Other treatments like needle fasciotomy (using a needle to perforate the cord) or enzyme injections (collagenase) exist, but open fasciectomy tends to give the most lasting improvement when contractures are advanced. It’s important to note that surgery is not a permanent cure, Dupuytren’s can recur over years , but it greatly improves hand function and finger straightness.
Surgery is typically considered when:
- Non-surgical treatments fail to provide sufficient relief or slow the progression of the condition.
- The contracture significantly impairs daily activities, such as gripping objects or performing fine motor tasks.
- The range of motion in the fingers is severely limited, with fingers being drawn into the palm.
The primary goals of surgical intervention are:
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Fasciectomy (open surgery) removes the thickened palmar fascia to free the fingers. Surgeons typically numb the hand and make small incisions to excise the diseased tissue.
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Other methods like needle aponeurotomy or enzyme injections are less invasive but often have higher recurrence. Open fasciectomy is widely considered the standard (“mainstay”) for significant contractures.
If you are experiencing significant limitations due to Dupuytren’s contracture, consult with Dr Oscar Brumby-Rendell to discuss the best surgical options tailored to your specific condition.
Types of Surgical Techniques
Surgeons tailor the procedure to the severity of the contracture. Two common approaches are fasciectomy and dermatofasciectomy (finger release):
- Fasciectomy: Small incisions are made in the palm to access the cords. The surgeon carefully removes the thickened fascia bands that are pulling the fingers. If a large section of tissue is removed, a skin graft may be used to cover the area and help healing.
- Dermatofasciectomy (finger release): This is a more extensive open surgery. It removes not only the diseased fascia but also the overlying skin if needed. In such cases, a full-thickness skin graft is usually placed to cover the excised area. Surgeons may also use minimally invasive techniques (like needle release) in combination to reduce trauma when appropriate.
Both techniques aim to straighten the fingers by removing or cutting the fibrous cords. The choice of approach depends on how much tissue is involved and whether the disease has recurred.
Scheduling a Consultation
To schedule a consultation with Dr oscar Brumby-Rendell for treatment for Dupuytren’s contracture, call (08) 7077 0101 or book online
Procedure Details
Surgical details vary based on the technique used and contracture severity:
- For a limited fasciectomy, the surgery is usually outpatient. The hand and arm are numbed (regional anesthesia), and several small incisions are made along the palm or finger creases. The surgeon removes the thick cords while preserving nerves and tendons. Often the incisions are left partially open (with a bandage) to drain, and you can go home the same day.
- For more extensive cases (large contracture or repeat surgery), general anesthesia may be used. If a dermofasciectomy is needed, skin grafts are often placed and the hand may stay overnight for monitoring. These larger surgeries have a slightly higher infection risk, so a brief hospital stay can be required.
Overall, Dr. Brumby-Rendell will personalize the procedure (incision type, anesthesia, use of grafts) based on your hand’s condition, balancing effective tissue removal with minimal impact on healthy tissues.
Post-Surgical Care and Recovery
Proper aftercare is crucial for a good outcome. Immediately after surgery, expect some pain, swelling, and numbness around the incision. Pain management (oral pain relievers and sometimes nerve blocks) is provided right away. The hand will be bandaged and often placed in a gentle splint to keep the fingers extended.
Your care team will instruct you to keep the hand elevated and apply ice (wraps or bags of ice) in the first days to reduce swelling. Keep the surgical site clean and dry, and follow wound care instructions (for example, avoiding wetting the hand until stitches are removed).
Immediate Post-Operative Care
In the first days after surgery, keep the hand elevated on pillows and apply cold packs to limit swelling. Take prescribed medications as directed for pain. A removable splint is usually worn to protect the fingers, and the dressing should be kept clean and dry.
Recovery Timeline
Your sutures (stitches) are often taken out around 10–14 days. After that, you’ll begin gentle finger movements and light exercises. By 4–6 weeks, many patients notice significant improvement in finger straightening and can do light daily activities.
Most people can return to desk work in a few weeks; jobs requiring heavy hand use or sports typically require closer to 8–12 weeks of recovery. Full strength and function continue to improve over several months.
Throughout recovery, hand therapy is important. A hand therapist or physiotherapist will guide exercises to improve range of motion and prevent stiffness. You will do stretches and strengthening moves at home. Night splinting is often recommended for about 6–12 weeks to keep the fingers extended while healing.
Frequently Asked Questions
Surgery is typically considered when non-surgical treatments fail to provide relief and the contracture significantly impacts daily activities, limiting hand function.
Dupuytren’s fasciectomy is highly effective in releasing contractures and restoring hand function. However, there is a possibility of recurrence, and ongoing monitoring may be necessary.
Recovery varies, but most patients see significant improvement within a few weeks. Full recovery, including returning to normal activities, may take several months. Physical therapy is crucial for optimal recovery.
As with any surgical procedure, there are risks, including infection, nerve damage, and recurrence of the contracture. Dr Brumby-Rendell takes every precaution to minimise these risks and ensure a successful outcome.
Why Choose Dr Oscar Brumby-Rendell?
Dr. Oscar Brumby-Rendell is a fellowship-trained orthopaedic hand surgeon based in Adelaide, with extensive experience in treating Dupuytren’s contracture. He combines advanced surgical skill with a compassionate, patient-centered approach.
Dr. Brumby-Rendell listens carefully to each person’s concerns and explains treatment options clearly. He is known for his dedication and integrity, crafting personalized surgical plans that aim for the best hand function and quality of life.
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