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.
I have Dupuytren’s contracture and Ledderhose disease, and I am considering amputation…End of problem!
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
I had open hand surgery and skin graft six years ago for dupuytren’s contracture. Despite knowing I have eczema my surgeon took the skin from inside my elbow joint. The surgery was unsuccessful and now my fingers are more contracted than ever. But my main problem is the eczema I now get inside my fingers and palm of my hand where the skin graft is. I am unable to wear gloves due to the contracture, so every day tasks are difficult as this irritates the eczematous skin and causes cracked skin, bleeding and intense itching. Any advice on this would be appreciated.
Greetings Helen,
Dupuytren’s contracture will always recur after surgery, and with each recurrence the degree of contracture will increase just as you have experienced. The only variable of Dupuytren’s contracture recurrence is the speed; some take many years to reappear while others take only a few months. Your surgeon should have explained this in detail prior to your hand surgery.
It is difficult to know how often Dupuytren’s contracture surgery is an out-and-out failure from the onset. I see many reports from people who have immediate pain, contracture, numbness, infections and crippling loss of use after Dupuytren’s contracture surgery that only worsens over time; they know as soon as their hand surgery is over that their problem is worse. The question in my mind is, what is the percentage of surgeries for Dupuytren’s contracture that fundamentally go wrong; how often does surgery for DC result in an immediate and obvious failure, as opposed to simple recurrence of the original Dupuytren’s contracture problem?
There is no way of knowing the rate or frequency of bad outcomes of Dupuytren’s contracture surgery because it is the surgeon who does the surgery (or the hospital in which the surgery is done) that is supposed to report these poor outcomes. Human nature, and the reality of business being what it is, makes this kind of reporting subject to distortion and manipulation. We all have heard of longstanding problems in the medical field that continue for years. When they say that the success rate for Dupuytren’s contracture hand surgery is high, I am only left to wonder.
When the Xiaflex field tests were done for Dupuytren’s contracture I know that some bad outcomes and bizarre reactions were not reported; side effects were kept hidden. Thus, Xiaflex was made to look a lot safer than what it is, and this is the reason that many people are now surprised by the terrible reactions that are being reported about Xiaflex.
You ask for advice, so I suggest you get a second opinion about your hand from a different surgeon than the one who your first hand surgery. My other advice is to consider trying something different to reduce the Dupuytren’s contracture you have. Since 2002 the Dupuytren’s Contracture Institute has studied how that process of self-healing works and how we can assist that process with Alternative Medicine. DCI’s efforts are intended to encourage and support self-healing of Dupuytren’s contracture in any way that makes sense. Sometimes the DCI Alt Med alternative treatment works and sometimes it does not help. Our success rate with Dupuytren’s contracture is that we get 8-10 reports of improvement (from moderate to marked) for every one report of failure., with no reports of ever making any DC worse or any kind of side effect as a result of our natural therapies. As we learn how to use the natural vitamins, minerals, enzymes and other therapies better perhaps the reports of improvement will increase. Please look over the information on the DCI website so you can learn how this can be done.
Good luck with your Dupuytren’s contracture, young lady. TRH
Is it possible to have needle aponeurotomy after Dupuytren surgery if the contracture returns?
Greetings RP,
Recurrence of Dupuytren contracture is what happens after any kind of hand surgery to remove the palm lump and finger cord. That is the nature of Dupuytren contracture: to make an excessive amount of collagen and fibrin in response to a stimulus like surgery.
It sounds like you have a recurrence after some kind of surgery to your hand. Now you are planning to use needle aponeurotomy to get rid of the recurrence. Is that right? Well, just because there is no incision made during a needle aponeurotomy does not mean that there will be no recurrence. Actually, a needle aponeurotomy often results in a faster and larger recurrence than a lot of other hand surgeries. Even the famous Xiaflex procedure, which is just another kind of surgery that is done with a needle and no scalpel, also results in recurrence of Dupuytren contracture. That is the nasty truth about Dupuytren contracture — there is no way to get rid of it by cutting or dissolving with Xiaflex (collagenase enzyme). It just keeps coming back. That is exactly why we talk to people every week who have 2-3-4 or more hand surgeries. They always think the next one will solve their problem.
Bottom line: Every kind of hand surgery for Dupuytren’s contracture carriers the very real risk of more Dupuytren’s contracture. That is the terrible truth of getting cut on for DC, more DC.
Better to try to help your body heal the thickened DC tissue with the DCI large treatment plan. Please let me know if you have any questions. TRH