Dupuytren Surgery Recurrence of Hand Contracture

Dupuytren surgery recurrence means only temporary relief

Dupuytren contracture recurrence is the return of excessive collagen and fibrin into the palm after hand surgery.

After speaking to well over a thousand people about their Dupuytren surgery recurrence history, DCI has found something amazing.  Just a handful knew hand surgery offers only temporary relief from the finger contractures before their surgery.  Most people did not know about Dupuytren surgery recurrence.  They thought hand surgery for Dupuytren was a one-time and permanent solution.

Recurrence of a second episode of Dupuytren contracture after the first surgery takes, on average 4-5 years, sometimes sooner and sometimes later.  For every example, while someone might have a recurrence in ten years, there are many others who have a return in just one or two years; and even a few months in a small percentage of cases.

Natural Dupuytren disease treatment can help          

Good news!  When people with early Dupuytren’s contracture use the large DCI treatment plan, good things can happen. DCI receives 8-10 reports of moderate to marked improvement, even elimination, of the palm lump when using the DCI large plan, for every one report of failure.

Using conservative self-treatment early before the cord has a chance to thicken and harden can avoid the need for Dupuytren’s surgery.

Most people DCI works with – and helps – are in early stage Dupuytren’s contracture. This is why we encourage those with palm lumps to treat their problem while it is small, soft and less embedded within the normal tissues of the hand. It is not wise to ignore the bumps on the palm.  Treat the abnormal thickened tissue while it is still small and more responsive to self-care.

Keep this in mind 

Here are important ideas to have in mind when thinking about Dupuytren surgery:

  1. After the first Dupuytren surgery, there is a good chance a person will have more. This is hte nature of Dupuytren’s contracture. To make excess collagen and fibrin and contracture the palm slowly.
  2. There is no such thing as cutting the Dupuytren’s tissue out and solving the hand problem. Some surgeons refer to cutting out a large and deep mass of tissue as creating a “firewall of tissue” to keep the problem from returning.  At best, surgery for Dupuytren contracture is only a delay technique.  It will always return; it is just a matter of time.
  3. After each Dupuytren surgery the next recurrence happens faster than the last one. For example, if your first-hand surgery has a recurrence in three years, a second surgery will have a faster recurrence – maybe two years.  And, another hand surgery would have a faster recurrence, maybe 18 months, and so on. This is why so many people with DC have 2-3-4 hands surgeries.  When they quit having hand surgery it is not because they are better; they quit because they are worse, and they learn it is not possible to get ahead of an aggressive case of Dupuytren’s contracture.
  4. After each hand surgery the recovery will be longer and more complicated with greater chance for side effects. Just like the recurrence problem increasing with each surgery, the amount of numbness, stiffness, pain, scar build up, reduced hand and finger movement and general limitation increases with each Dupuytren surgery.
  5. If your hand has been so scarred, and so much tissue removed by prior surgeries, and pain and limited use of the hand develops, a common solution is to amputate the offending finger(s).

Don’t worry about Dupuytren surgery recurrence

There is no need to be concerned about Dupuytren surgery recurrence if you do not need hand surgery.

None of these surgical procedures is a way to stop or cure Dupuytren contracture permanently.  At best, the purpose of Dupuytren’s surgery is to increase finger movement to some degree.  That movement might be increased a little or greatly, but the increased finger straightening is only temporary before the excess collagen buildup reduces causes the finger to once again curl down and flex into the palm. In extreme cases, amputation of fingers may be needed for severe or recurrent disease, or after complications in surgery.

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Different types of Dupuytren surgery recurrence evaluation 

  • Regional Fasciectomy: Most common Dupuytren surgery. The contracted palm tissue is surgically removed.  Requires general anesthesia or a nerve block.  Needs extended rehabilitation and wound care. Recurrence of Dupuytren contracture is somewhat more frequent than after other types of Dupuytren surgery.
  • Fasciotomy: Less common Dupuytren surgery.  Requires single or multiple incisions (usually in a zig-zag pattern) using widespread dissection over the Dupuytren’s cord, but the diseased tissue remains in place.  The idea is to open up the offending tissue to relieve pressure and tension in the palm.  Also requires general anesthesia or a nerve block.  Requires extended rehabilitation and wound care. Recurrence is slightly more frequent than a regional fasiectomy.
  • Dermofasciectomy: Less common Dupuytren surgery.  Surgical removal of diseased skin and fascia overlying Dupuytren cords, in which diseased soft tissue of palm is replaced with a skin graft from patient’s forearm.  Requires very long rehabilitation and wound care.  Recurrence is somewhat less frequent than regional fasciectomy.
  • Needle Aponeurotomy (NA): Very popular – almost faddish – in-office procedure.  Needle aponeurotomy is a minimally invasive Dupuytren surgery.  A needle tip slashes around under the skin of the palm to shred and weaken the Dupuytren cords.  Afterward, each  cord is broken by hyperextending or pulling each finger straight.  Local anesthesia used.  Requires short rehabilitation and minimal wound care.  Recurrence is average.
  • Xiaflex (collagenase) injection:  In 2010 the US Food and Drug Administration approved injectable Xiaflex to be used in treatment of Dupuytren contracture.  Collagenase erodes the Dupuytren cords when they are injected with small amounts of this enzyme, breaking the peptide bonds in the cords of collagen.  Recurrence of hand and finger contractures seems to be most frequent with this technique.