My hands got worse after Dupuytren’s surgery, what can I do?

Strategy to avoid risks of Dupuytren hand surgery   

All surgery has risks. Even the most simple and direct surgery can result in an unexpected bad reaction.  These can occur due to human error and judgment issues, or simply for reasons that are unavoidable and totally unexpected.

Complications after open hand surgery for Dupuytren contracture  (palmar fasciectomy) is variously reported to occur in 17% to 41% of cases, clearly higher than for many other types of surgery.  While the side effect and complication rate for needle aponeurotomy (palmar fasciotomy) is much lower at 2 to 4%, this must be weighed against its much faster Dupuytren recurrence rate and the need for additional palmar fasciotomy surgery sooner and more often.

It is important to understand that chances for adverse reactions after either of these two types of hand operations are at least doubled when performed as a second or third Dupuytren surgery.  Simply stated:  1. The more often palmar fasciectomy or palmar fasciotomy are performed the riskier each succeeding surgery becomes, and 2. repeat hand surgery is performed because of the high rate of recurrence of Dupuytren contracture after surgery.  With each surgery normal anatomy changes and less useable tissue remains.  Sooner or later so little tissue is left for the next surgeon to use, until no more hand surgery can be done.

Avoid or delay palmar fasciectomy surgery with Alternative Medicine

Those considering a second or third Dupuytren surgery after a needle aponeurotomy (palmar fasciotomy) or open hand surgery (palmar fasciectomy), should be interested to consider natural Dupuytren treatment as a possible way to postpone or avoid another hand surgery.

To learn about Alternative Medicine self-management, please see Different Way of Looking at Dupuytren Contracture Treatment

Medical researchers, Loos, Messina, and Bulstrod report successful outcomes of Dupuytren treatment using massage, exercise and traction, all without surgery.  Even so, not much interest is given to their work because research funding is always focused on high profile surgery and drug therapies. Natural therapies of Alternative Medicine are not a high profit way to treat Dupuytren contracture, although the Dupuytren Contracture Institute has been providing insight and assistance since 2002 to help people deal with their hand problems.

Not all people respond well to drugs and surgery, and not everyone responds to Alternative Medicine.  And just as no one in the practice of medicine can say with certainty that any drug or surgery will be successful, no guarantee can be offered that non-drug and non-surgical natural methods will assist your recovery. Even so, the advantage of using a simple and low cost Alternative Medicine approach is that when it does successfully assist the body to recover from a health problem, the need for drugs and surgery is lowered, delayed or eliminated.   Another major advantage is the well known low risk of natural therapy compared to drugs and surgery.

For those who have never had Dupuytren surgery, the conservative option is to undergo a short therapeutic trial of care with natural remedies first – rather than last – to possibly avoid hand surgery.  For those who have had one or two Dupuytren operations, the conservative option is still open but with reduced expectation.  In these cases the body has less normal tissue to work with; results cannot be as good as when surgery was never performed.

In the experience of the Dupuytren Contracture Institute working with those who have had one hand operation, it is possible to eliminate the need for a second surgery and cause doctors to change their recommendation for the need of a second surgery.  With a brief trial of Alternative Medicine treatment it is possible to make positive tissue change and either avoid or delay the need for surgery.

Rapid recurrence of Dupuytren contracture means more hand surgery later

Many who write on Dupuytren’s forums express the cavalier notion that they are willing to submit to needle aponeurotomy every few years even though recurrence is more rapid with this type of less invasive hand surgery.  They explain that they prefer NA because recovery is so rapid or they can use their hands in a few days with no rehabilitation. They fail to calculate that this does not necessarily happen each time needle aponeurotomy is done. They do not consider the risk of an adverse reaction increases with each surgery, preventing this approach to be used indefinitely.

For those who already have had one Dupuytren’s hand surgery and want to avoid another, this article presents possible avoidance options as well as the potential complications and risks of palmar fasciectomy, also known as Dupuytren’s contracture open hand surgery.

Bad reaction after Dupuytren’s surgery, what is next?

The idea that it is possible to correct a bad surgery with another surgery must be examined very closely.  While there must be cases where this works out well for the patient, extreme caution must be used to assure a bad situation is not made worse by additional irreversible tissue changes of compounded surgery.

First, get a second surgical opinion but not for the reason many people think. Patients typically approach a second medical opinion only to see if it agrees with the first.  This is often just another way of allowing two doctors to make a decision for a patient. The best use of a second doctor’s opinion is to receive additional medical information and a different view point to round out the thinking of the patient.  Both medical opinions should supply information to help the patient decide the next step to take.  It is the patient who must ultimately decide the best course of action to take to return to health.  When the patient does not feel capable of making that kind of decision, it is the fault of the doctor who has not provided adequate information to the patient.  Find another doctor who will talk to you and explain things in such a way that you can make this decision!

In no way is it suggested that a layperson can know more about the practice of medicine than the doctor.  Even so, the layperson must ask questions and receive answers from at least two doctors so she is able to make an informed and intelligent decision about her care – not the doctor.  A lazy patient does not get the best care.

It is the responsibility of the patient to assure that a second surgery is the best step to take – as it might be. Too often patients rely solely on the judgment of the first doctor they encounter to make important decisions for them.  This is not wise.

If you do not like the thought of additional Dupuytren surgery, for whatever reason, you can consider attempting Alternative Medicine treatment for a month or two or more to learn if your body is capable of reversing the abnormal hand contracture.  If it helps your situation and surgery is no longer indicated, look what you have gained.  If it does not help, you can have surgery knowing you have not been hasty, you have used conservative measures appropriately, and whatever reaction occurs from a second surgery was indeed unavoidable because less aggressive measures did not help you.

Suggestions to determine if your body is capable of changing the soft tissue contractures in the palm and fingers:

1. Learn about your Dupuytren problem from a different standpoint.  You were told you needed hand surgery by the MD who gave you the diagnosis of Dupuytren contracture.  Almost all internet information about Dupuytrens promotes surgery.  Go to the home page of the Dupuytren Contracture Institute for holistic information about day-to-day treatment. The information found on this website is unique because we present the idea that not all Dupuytrens needs surgery.

2.  Determine the most aggressive Dupuytren therapy plan you are comfortable following.  For best results do all that you can to help yourself.  Consider using what is called the “Large (Best) Plan” for personal treatment.  The “Medium (Better) Plan” is the most popular of the DCI plans.  The “Small (Good) Plan” is also well designed.  These three plans are found at the top of the page at Dupuytren treatment plans.   Any plan can be modified by subtracting or adding to suit your personal Dupuytren contracture treatment philosophy.  These plans are only examples of how to approach this problem, and have helped hundreds of people over the years.

3. Stop feeling discouraged. Read the Dupuytren Hand Bump Forum.  Get educated, motivated, and reminded that everyday around the world there are people who are actually beating their Dupuytren problem following the Alternative Medicine methods of the Dupuytren Contracture Institute.

Complications of open hand Dupuytren surgery (palmar fasciectomy)

No one, not even a surgeon, can predict the side effects and complications of a particular surgery – and that is the problem.  While many patients, even a majority, receive a palmar fasciectomy without an adverse reaction and no post-surgical complication at all, there are those who are worse after surgery.  The number or percent of adverse surgical cases is not important if you are one of the unlucky patients whose outcome is poor. The only bad outcome that matters is your own.

Keith Denkler, MD, in 2010 wrote, “Surgical Complications Associated with Fasciectomy for Dupuytren’s Disease: A 20-Year Review of the English Literature.”   His final comments,
“In conclusion, results of this study underscore the importance of
treating Dupuytren’s as an incurable genetic disease understanding that
surgical excision, fasciectomy, has a high rate of major and minor
complications. Surgeons must understand that while fasciectomy for
Dupuytren’s does offer a chance at long-term ‘straight’ fingers, there is
a high cost in terms of numbers of complications that are borne by the
patient.”

Because the hand is a highly complex and densely packed machine with practically no space separating very delicate nerves, blood vessels, muscles, ligaments, tendons, and fascia, the patient must carefully select the best surgeon for the best hand operation outcome.

The Dupuytren Contracture Institute is not against hand surgery.  DCI only suggests it is a prudent step to first try Alternative Medicine to learn if their Dupuytren soft tissue problem is partially or completely reversible, thus making surgery unnecessary.  If the need for Dupuytren hand surgery remains after natural methods has been unsuccessful, find the best surgeon possible.

Comments

2 Responses to “My hands got worse after Dupuytren’s surgery, what can I do?”
  1. Kevin Town says:

    I have Dupuytren’s contracture and Ledderhose disease, and I am considering amputation…End of problem!

  2. Dr.Herazy says:

    Greetings Kevin,

    I hope you are only kidding. Amputation is not the end of your problems with Dupuytren’s contracture and Ledderhose disease, just the beginning of a new kind of hand and foot problem.

    Although I know that there are a lot of people who do not take their Dupuytren’s contracture problem seriously because they think they can always rely on surgery to cut off what is bothering them, you should reconsider your attitude. If you could only read some of the emails and hear the phone conversations I have with people who had so many “curative” Dupuytren’s contracture surgeries that they felt they no other option than to have one or more fingers and parts of their palms amputated.

    Just because the cords and contractures are no longer present does not mean that a person’s life is pain-free or without problem. I have communicated with many men and women to know that for many of them the pain still is felt in the parts of the hand and upper extremity that remain – sometimes worse than before. This is to say nothing of the frustration and constant problems of having only a partial hand to work with. You are being short-sighted to think that this is any way a good solution for your problems. You should think this through. TRH

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