When to have Dupuytren surgery?

Hello Dr. Herazy,

I have spent a few hours studying your interesting website.   Thank you for making such a helpful website available that presents a different side of the story about what a person should do for Dupuytren’s disease.

I have many questions right now, but I suppose my biggest is  “how does a person know it is time to actually have Dupuytren surgery?”

Thank you,

Lela from Delaware

Greetings Lela from Delaware,

From a medical standpoint there are a few very standard and simple tests that are generally used to determine who is and who is not a good surgical candidate – although this decision should not be made solely on the basis of a few numbers and angles, and a simple tabletop test.

Generally, Dupuytren surgery should be reserved for those who have hand contractures that keep the involved finger(s) at 30° flexion, or when the individuals has a positive tabletop test in which both the palm and fingers  cannot be held flat against a tabletop.  This makes the decision sound easy, but there are many more things besides age, past surgical history and the state of general health  to consider.

In my opinion, when considering to undergo a Dupuytren release it is good to remember that no hand surgery for Dupuytren offers a permanent correction; all are a temporary solution because recurrence of Dupuytren contracture will happen sooner or later, usually within five years or so.

A Dupuytren release involves making one or a series of incisions into the palm to remove the dense, thick, contracted and inflamed soft tissue (fascia) that surrounds, supports, and separates the tendons and tendon sheaths of the fingers and hand, while preserving the arteries, veins and nerves, correcting joint deformities, preserving uninvolved skin, and maintaining proper flexion and grip strength.

A Dupuytren release does not cure or eliminate the disease.  When it works out well it only temporarily modifies the progression of the disease and temporarily improves hand function. When it does not work out well it can result in a worse problem than before the release surgery.  Recurrence is still likely after Dupuytren surgery.

The time to have Dupuytren surgery is when you have attempted to do every thing you possibly can to avoid it, and you have been unsuccessful.   Additionally, there should be a strong feeling that you are willing to accept the risks involved and tolerance for the idea you might have to have additional hand surgeries in the future.

Before you submit to hand surgery I suggest that you attempt at least a few weeks of an intense program of natural therapies that we describe in Dupuytren Contracture Institute website.  For a good place to start reading and learning, go to Start Dupuytren Contracture Treatment

Dupuytren Release

Dupuytren release is not one type of hand surgery

The term Dupuytren release refers to either of two types of hand surgery: fasciotomy or fasciectomy.  Either of these can be provided to release the thickened and shortened contracture of the hand lump associated with Dupuytren’s disease, resulting in a temporary reduction or release of the tightening and flexion of one or more fingers.

When considering undergoing a Dupuytren release, remember that no release procedure offers a permanent correction; all are a temporary solution because recurrence of Dupuytren contracture will happen sooner or later, usually within three to five years or so.

Dupuytren surgery should be reserved for situations in which the hand contractures keep the involved finger(s) at 30° flexion, or when the individual has a positive tabletop test in which both the palm and fingers  cannot be held flat against a tabletop.

A Dupuytren release involves making one or a series of incisions into the palm to remove the  thick, contracted and inflamed soft tissue (fascia) that surrounds, supports, and separates the tendons and tendon sheaths of the fingers and hand, while preserving the uninvolved skin, arteries, veins and nerves, correcting joint deformities, and maintaining proper flexion and grip strength.

There are five different surgical methods that are termed a Dupuytren release:

  1. Partial or selective fasciectomy – most common Dupuytren release, during which one or more incisions are made across the palm, dependent upon the size, depth and location of the nodules, cords and contractures, as well as history of prior Dupuytren release surgeries and hand trauma, age and occupation. Recurrence  somewhat more frequent than after other types of Dupuytren surgery.
  2. Subcutaneous fasciotomy – Less common Dupuytren surgery.  Single or multiple incisions (usually in a zig-zag pattern) for widespread dissection over the contracted tissue, but diseased tissue is not removed.  Recurrence is slightly more frequent than a regional fasiectomy.
  3. Complete fasciectomy – Rarely indicated because of frequent complications and frequency of recurrence. .
  4. Fasciectomy with skin grafting – Less common Dupuytren surgery.  Surgical removal of diseased skin and fascia overlying Dupuytren cords, in which diseased soft tissue of palm replaced with a skin graft from patient’s forearm.   Recurrence is somewhat less frequent than regional fasciectomy.
  5. Amputation – performed after failed Dupuytren release surgery or after multiple recurrences where no additional surgery is possible.

Dupuytren release not a cure

A Dupuytren release does not cure or eliminate the disease.  When it works out well it will only temporarily modifies the progression of the disease and temporarily improves hand function. When it does not work out well it can result in a worse problem than before the release surgery.  Recurrence is still likely after Dupuytren surgery

Since 2002 the Dupuytren Contracture Institute has maintained that an initially conservative approach to treatment is most prudent and defendable.  If after following a moderate term course of intense non-invasive Alternative Medicine treatment of Dupuytren contracture there is a lack of sufficient response, then more radial invasive measures can always be explored.

The normal and full use of your hands can be taken from you as Dupuytren contracture progresses.  There is an alternate way to do all that you can, as early as you can, to allow your body the best opportunity to naturally reverse this problem.

For ideas and suggestions to organize an effective Alternative Medicine treatment plan, to possibly avoid the need for Dupuytren release surgery, click natural Dupuytren Treatment Plan.

For more information about trying to avoid Dupuytren surgery:

>> Dupuytren Contracture Treatment – FAQs

>> Testimonials from Dupuytren Contracture Institute

>> Dupuytren surgery