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.

 

4 thoughts on “Why you should think twice about Dupuytren’s surgery

  1. Ruth Wall says:

    I had a fasciotomy on my left hand for Dupuytren’s contracture after successful surgery on my right hand. After a few months the area around the scar became very sensitive — like having a thorn in the scar. It also became inflamed. The surgeon thought there may be a broken suture but further surgery only led her to assume it was lumpy scar tissue that was causing the problem so it was removed. 2 months later it feels the same — like I’m holding a thorny rose stem. I don’t think it can improve?

  2. Dr.Herazy says:

    Greetings Ruth,

    Localized and intense hand pain happens after Dupuytren’s contracture hand surgery more than you would imagine; it is not at all rare. People just do not talk about it after a while, and surgeons seldom report it to their hospital peer review committees or to patients before surgery. Surgical complications, side effects and bad outcomes are extremely difficult to measure since they are supposed to be self-reported by the offending surgeon; hence, it is seldom done. For these reasons patients are unaware of potential problems with a particular surgeon or a particular procedure.

    It is possible your current pain in or near the hand scar could be the beginning of recurrence of your Dupuytren’s contracture. Recurrence or return of the original problems is another complication after a fasciotomy for Dupuytren’s contracture that surgeons downplay or simply do not tell patients about before hand surgery. It is said that Dupuytren’s contracture will always recur or return after surgery to remove it; sometimes the process will be fast (like a year or less), and sometimes recurrence will be slow (like 10-15 years or more). From what I have been told by the countless people who communicate with DCI, Dupuytren’s contracture recurrence after hand surgery seems to begin after an average 2-3 years. This tendency to recur so soon after surgery makes the risks, distress and pain involved hardly worth it.

    Please be sure to consider a non-surgical treatment approach if in fact your Dupuytren’s contracture does recur. Good luck to you. TRH

  3. Greg Ross says:

    I recently had surgery for my Dupuytren’s Contracture on my left hand due to severe contractures on both my pinky and ring finger and to a lessor degree on my middle finger. Earlier, three months earlier, I had surgery on my right hand for severe contracture of the pinky. One year prior to the right hand surgery I had Xiaflex injections on the right hand to correct the Dupuytren’s, this was successful at first, however the pinky returned to the 90 degree position within 6 months, hence the decision to go ahead with the surgery, with the assurance the result would be improved with the surgery. To its credit, the Xiaflex did correct the nodes and cords in my palm. The right hand surgery was successful to a degree. My pinkie is now at a 30 degree contracture, but more importantly, is has been released so I can align all my fingers together, make a tight fist and carry heavy loads with no difficulty. The post surgery on my right hand was painless after the second day of surgery. To this point my right hand surgery was successful and I have improved use of the hand prior to the surgery.

    With the results of the right hand as a semi indicator of what to expect, I entered into the surgery of the left hand feeling confident of similar results. I knew that the recovery would be longer since two fingers versus one would be opened up from the tips to the lower part of the palm, however, what was to come was NOT anticipated. I now have been diagnosed with having Carpal Tunnel, resulting in extreme neuropathy on the right side of the main muscle of my left thumb to include both my index and middle finger.

    Prior to the Dupuytren’s contracture surgery I never experienced any signs or symptoms of Carpal Tunnel. Further complicating matters is the swelling of the fingers that were operated on has not gone down, resulting in the inability to make a fist, complete numbness on the ring finger and an extremely weak grip. If I try to do my hand strengthening exercises recommended by my OT, the following day the swelling and pain will worsened. I suspect the newly acquired carpal tunnel may be the result of post tourniquet neuropathy since the bruising around my wrist was severe and when tapped on the nerve pain shoots up through my palm to the finger tips. I’m also experience constant phantom pains throughout the same area 24hrs per day. My PA stated that the carpal tunnel is a result of wrist swelling and not post tourniquet neuropathy. Regardless, I now have carpal tunnel where as before the surgery my hand never experienced neuropathy, extreme, weakness and shooting nerve pain. My PA said I need carpal tunnel surgery asap as my main thumb muscle is experiencing atrophy since I have minimal hand strength. Understandably I’m very leery of additional surgeries at this point. One more note, as my wife would say, I have a considerable pain tolerance, having ACL replacements, broken ribs and other injuries throughout my life as both an alpine and cross country skier, hiker, mountain bike rider and many other outdoor sporting venues, but the nerve damage, and neuropathy resulting from this surgery has been the worse, its like a large burn from my wrist up to my finger tips. Presently I’m taking Gabapentin for the nerve pain which is masking the pain and allowing me to sleep with the aid of Ambien.

    I worry about the continuation of this drug mix. I’ve never been one to take medications and its frustrating having to go this route. Hoping time and continual hand use will work things out.

  4. 88TRH88 says:

    Greetings Greg,

    Sorry to hear of the various problems you are having after Dupuytren’s contracture surgery; it is not at all that uncommon. Based on all the stories I hear, it seems it is far more common to have long-duration or permanent complications (pain, numbness, loss of use, etc.) than it is to have no complications.

    Keep in mind, please, that your body is still healing from the removal of a great amount of tissue from a very delicate and complicated part of your body. Some of your current complaints may go away in a few months, and others might not. I would not be too quick to assume the worst, or the best. You mention how successful your Xiaflex procedure was, but you also mention several problems that have worsened as a result of it. Keep in mind too that if you had not had the Xiaflex injections you might not have needed the second right hand surgery if you did not receive the Xiaflex injections.

    I suggest you get a 2nd opinion, and maybe even a 3rd, before having more hand surgery. Sometimes these situations can go downhill very fast when multiple surgeries are done.

    It is always best to avoid surgery, if possible. The DCI non-drug treatment has a good success rate; 8-10 reports of moderate to marked success for each one report of failure when our protocol is used correctly for at least 3-4 months. And there are no side effects.

    Best of luck to you, sir. TRH

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