Why you should think twice about Dupuytren’s surgery

Specific reasons to be wary of hand surgery for Dupuytren contracture

Few people are overly eager to have surgery for Dupuytren’s contracture simply because they are not comfortable with the cutting and bleeding associated with any surgery.  However, there are specific and unique complications and side effects that occur as a result of surgery for Dupuytren contracture that should stir even more caution.

Because Dupuytren’s surgery, even when done well, can lead to unsatisfactory results and stimulate the recurrence of new cords and nodules in the palm, the Dupuytren Contracture Institute since 2002 has proposed the use of conservative non-surgical and non-drug methods to help the body reverse and even eliminate the Dupuytren nodules and cords.  For more information please see Different Way of Looking at Dupuytren Contracture Treatment

Limitations of Dupuytren surgery

Each Dupuytren surgery candidate must remember there are limitations to what can be accomplished in this kind of hand surgery:

1.  Every Dupuytren patient thinks, “I will get this surgery for my Dupuytren problem and then I will be OK.  I will be normal again.”  That is not the case.  Surgery will not restore the hand to its original condition.  Even though surgery might remove all or some of the diseased tissue, Dupuytren contracture is notorious for recurring in a few yesrs.

2.  After Dupuytren’s hand surgery complications (greater pain, greater loss of hand/finger mobility and dexterity, hand coldness, numbness, sensitivity to pressure and touch) occurs in 20-50% of cases when nerves and blood vessels are cut, and scar tissue develops.

3. After any of the different palmar fasciectomy types of surgery there is less normal tissue in the hand, even when healthy skin is grafted in to close the open wound and replace diseased tissue.  Since the graft comes from another part of the body, it will react differently when in the palm. If a tissue graft is not used, it is necessary to reconnect open wounds, resulting in a hand that has less tissue in it. This results in reduced finger and hand movement, reduced hand strength and alteration of the tissue bed that nerves and blood vessels lay in, resulting in a hand that is “better before the hand operation, but still not right.”  This outcome is common, and all people I speak to are surprised because these things were never explained before the Dupuytrens operation.

4. Given enough time – usually just a few years and sometimes a little as one – Dupuytren contracture will likely recur again at the same site as a prior surgery, or in tissue adjacent to prior surgery. This idea of post-operative recurrence of Dupuytren contracture makes many wonder why bother having the surgery if the problem will recur and additional surgery will be needed.

For these reasons DCI contends it is better to be conservative first, and then try aggressive Dupuytren surgery later if it is still needed.

Reality of Dupuytren’s surgery

When a patient with Dupuytren contracture speaks to a hand surgeon the doctor will often say something like, “This will be a really simple surgery.  I have done hundreds over the last 10 years. The results are very good.”   Any potential surgical patient would like to hear that while trying to decide to have surgery for Dupuytrens.  That is why the doctor would say it that way; to make it easier for the patient to decide to have surgery.

Of course the doctor says the hand surgery is simple and easy from his or her standpoint; it probably is compared to other surgeries.  What the patient might envision after hearing it is a “simple surgery” would be to minimize the process to make it easier to accept the idea of having it done.  The patient would tend to think, “The doctor said it is a simple surgery, so maybe it is like when I had my tonsils removed or when I had that boil on my back lanced.  Those were pretty simple, so maybe this will be just like that.”  And of course, nothing could be further from the truth.

It is always wise to have surgery done by someone considerable with the same kind of problem – the longer the time and the greater the number of surgeries, the better.

But, from my experience, when a surgeon comments that the results of a particular hand surgery are “very good” or a similar expression, it would be wise for the potential patient to ask a few questions to clarify what the doctor actually means.  When a doctor thinks the surgical results of a palmar fasciectomy are “very good,” the doctor has something else in mind that is much different than what the patient is thinking.

The doctor is thinking soberly about the current level of the patient’s problem in terms of greatly limited hand use and degrees of joint deformity.  The doctor might consider the operation to be highly successful because before surgery the little finger was locked at 80 degrees and after surgery for Dupuytren’s contracture the little finger is at 20 degrees flexion.  To accomplish this increase the doctor might not be disturbed that his surgery also resulted in pain and numbness that the patient never had before, or weakness that causes him to be unable to open doors with that hand.   The doctor might not also be bothered that his patient will again have recurrence of Dupuytren contracture in that same finger a few years after the first hand surgery.  In spite of this the doctor will contend the surgery results were “very good.”

The patient is thinking emotionally about what the doctor said in relation to the “very good” results of his proposed surgery for Dupuytren contracture.  For the layperson “very good” means almost like brand new.  Full range of finger movement; being able to put his hands in his pockets again, brush his teeth and comb his hair like a normal person, and all the things he did before he developed Dupuytren contracture. And, of course, this patient is not even remotely thinking about developing new problems like pain and numbness after surgery. Lastly, the patient will be most surprised when the Dupuytren contracture returns in a few years, usually worse than the first time. How could any of that happen if the doctor said the results are “very good”?

Not against surgery for Dupuytren contracture

With no drug treatment for the contracted hand tissue, traditional medicine offers Dupuytren surgery as their only cure. DCI is not against surgery for Dupuytren’s contracture.  DCI’s position has always been to recommend surgical intervention in those cases that have not responded to an aggressively applied round of conservative Alternative Medicine therapy.  If someone has attempted to reverse or reduce their hand contracture with limited results then they should seek out an evaluation of two doctors who specialize in Dupuytren’s hand surgery.

Yet, people often approach the management of their Dupuytren contracture in the reverse order:  They first receive one or more surgery for their Dupuytren’s problem and upon seeing the limited response or worsened condition they are in, will only then think in a conservative direction.

People from around the world report to DCI that they rushed into their hand surgery thinking it would be an easy and sure solution to their palm nodules and contractures.  This is often not the case; in some cases their hand is worse after Dupuytren’s surgery.

It is DCI‘s opinion that it is safe and reasonable to attempt to improve the body’s ability to heal and repair the problem of Dupuytrens contracture by aggressively using several conservative Alternative Medicine treatments that are based on sound science and common sense. We strongly suggest that anyone with Dupuytren contracture works with what is known and what is available – even if it is not perfect – before undergoing potentially risky surgery for Dupuytren’s disease.   If DCI’s conservative concepts do not help your hand lump, you can always have Dupuytren surgery later.

 

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