Why not perform hand surgery before my Dupuytren contracture gets worse, while it is still small?

Hello: I have just recently been diagnosed with Dupuytren’s contracture. I noticed a small hard bump/lump appear in the palm of my right hand, as well as one on the bottom of my right foot. I have just turned 50 and I am female. If the outcome is ‘black and white’, why not perform hand surgery to remove the bump BEFORE it grows into a long band deforming the fingers / toes?  Why wait ?

 

Greetings,

The answer is simple:  Dupuytren contracture recurrence after surgery. For more discussion of this topic see Dupuytren Surgery and Recurrence of Hand Contracture.

You are a little younger than average to develop Dupuytren’s contracture (hand) and Ledderhose disease (foot), and for this reason you are more likely to have an ongoing problem with Dupuytrens; the earlier in life it starts, the more aggressive and difficult the palm lumps and cords tend to be.  Your doctor is trying to delay your surgery for Dupuytren’s contracture to delay the time when your first recurrence starts.

Let’s say you had hand surgery the way that you propose.   If you had your first Dupuytren’s operation at age 50, it is possible to have your first recurrence start within two years.  Following your idea of early surgery to prevent progression of the problem, let’s say you had your  second hand surgery as soon as the recurrence appeared, and the next Dupuytren’s recurrence again appeared within the next two years.   Following your idea of early surgery to prevent progression of the problem, let’s say you had your  third hand surgery as soon as that next recurrence appeared,  and the next recurrence again appeared within the next two years.   Again, you would theoretically have another surgery for Dupuytren’s recurrence, with another recurrence, and so on. 

The above example does not work for three reasons:

  1. Recurrence of Dupuytren’s contracture tends to accelerate with each surgery, so that if the first recurrence did take two years to eventually develop, the net recurrence would be a little faster or sooner; maybe 18 months.  And if you had another hand surgery after that recurrence, the next recurrence would theoretically be even faster or sooner; maybe 12 months.   Of course, all these numbers are just made up, and could be faster or slower depending on your individual characteristics, family history, life history, clinical information and luck.   Some people wait 10 years for their first recurrence of Dupuytren’s contracture, but some people wait just a year – or even less for their first recurrence to appear.  Once the surgery starts, the process of recurrence starts; it is inevitable.   
  2. Each Dupuytren’s surgery “uses up” or removes normal hand tissue.  You cannot have too many hand surgeries without soon having little normal tissue remaining.  Depending on your individual circumstances you might only be able to have one, two or three hand surgeries in your life before your surgeon would inform you that you cannot have any more.   What do you do at that point?  You allow it to get worse, and perhaps become so bad in terms of pain that amputation is your only option. 
  3. No good surgeon would perform an early Dupuytren surgery, such as you have proposed.  Hopefully you would never find a surgeon who would agree to cut early, because he/she would know that this would be a terrible decision that would lead to a terrible result.  

There are drugs that have risks that can be used, and there is surgery as an option for you to consider. I suggest that you should consider trying to avoid Dupuytren’s hand surgery completely.  Since your problem is early and small at this time you are in a good position to try to reverse this process naturally.  I suggest you do some reading to see if this makes sense to you.  You can always try it for 2-3 months of intense natural therapy while you are waiting for your Dupuytren’s to progress.  If it work, fine – look at what you have gained.  If it does not work, as sometimes happens, you can always have your hand surgery when your surgeon thinks you are ready for it.  

For further information about treating Dupuytren’s contracture naturally you can read What is the best therapy to treat Dupuytren contracture?    TRH

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