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This simply means cutting the tight cord or band of tight tissue. It can be performed by percutaneous and open methods. There have been a number of articles in the press relating to the percutaneous technique, especially from Paris. This procedure is performed as a daycase under local anaesthesia and simply involves the cutting of the tight band of the contracture. In my opinion, this is best performed in theatre and I make a transverse incision which becomes a rhomboid gap when the finger is straightened. A bit like the bulging shirt!
This can often regain up to 40 degrees of straightening of the finger. It is not designed to be a cure but in some patients it is a useful procedure as the recovery process is much less involved than the alternatives. A bandage is still required for the first 2-4 days but then can be reduced to a simple elastoplast type waterproof plaster, which is usually required for a couple of weeks. No stitches are used, the 'hole' simply fills in.
This is the commonest operation performed for Dupuytren's contracture. It involves opening up the skin of the palm and then carefully dissecting the tough fibrous tissue away from the adjacent nerves and vessels so that it can be safely removed.
The incision I prefer is longitudinal as it allows me to adjust the length of the wound to accommodate for skin tension using a technique called a "z-plasty". A useful, much more detailed description of a z-plasty can be found at the following link The Basic Z-Plasty
Please follow the instructions following surgery with respect to elevation, cleanliness and pain relief etc. as described in the General Advice section.
The first clinic visit will be the following week and you will be seen either by the Hand Therapist, by myself or by one of my junior surgeons (at RBH). It may be necessary to make a special splint to support the hand at this visit.
Once the wound has healed (usually 2-3 weeks) then all dressings can be dispensed with. Depending on the initial severity of the contracture you may be required to use the splint for longer and especially at night (sometimes for up to 4 months post-surgery).
Remember there is always the potential for a Dupuytren's contracture to recur!
