Tag Archives: risk

Dupuytren hand surgery can be dangerous: Facts you should know

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Risks of hand surgery as a limited Dupuytren treatment

Any type of surgery presents risks and can produce unintended side effects.  Unanticipated complications following open hand surgery for Dupuytren contracture has been reported in 17% to 41% of cases.  Further, these side effects are nearly twice as likely to occur for repeat surgery when Dupuytren’s contracture recurs after a first surgery.

This article will focus on the potential complications of Dupuytren’s contracture surgery, specifically a category called palmar fasciectomy.

Avoid Dupuytren hand surgery with Alternative Medicine

Anyone considering Dupuytren surgery should be encouraged to know that by natural Dupuytren treatment it might be possible to avoid a hand operation.

Medical research by Messina, Loos, and Bulstrod report successful outcomes for Dupuytren contracture after using the non-surgical methods of massage, exercise and traction, yet their work receives little attention.  Research interest has always been primarily directed toward high profile profitable surgery and drug therapies. Alternative medicine is not a high profit way to treat hand contracture although the Dupuytren Contracture Institute has been helping people since 2002 deal with their hand problems.

Not all people respond to Alternative Medicine, just as not all people respond well to drugs and surgery.  However, the advantage with using simple and low cost natural therapies and remedies is that when they do successfully assist the body to recover from a health problem, the need for drugs or surgery is lowered or eliminated.  The idea of attempting a short therapeutic trial of natural remedies first, rather than last, takes advantage of conservative ideas at the beginning of care.  Later, if Alternative Medicine fails to assist the healing response then more aggressive drugs or surgery can still be used.

The Dupuytren Contracture Institute is not against hand surgery for Dupuytrens contracture.  Obviously there is a need for surgery when natural methods have been unsuccessful.

The risk and limitation of Dupuytren surgery should be considered not only because of the potential permanent consequences (permanent pain and numbness, reduced finger movement, reduced hand strength) that can occur, but also because surgery is not the only option to reduce palm lumps and finger cords.

Hand surgery is not final

Two primary cautions should be kept in mind before submitting to surgery for the hands: First, even when Dupuytren’s surgery is done well by a skilled surgeon, unintended consequences occur that no one can anticipate or explain.  Second, Dupuytren surgery is well known to   stimulate the recurrence of additional nodule and cord formation in the palm after removal – sometimes as soon as in a single year, often three or four years.  Since Dupuytren contracture is famous for recurrence within a few years after surgery, anyone thinking about a surgical option should realize that once the first surgery is done it is just a matter of time before the next surgery will have to be done.  The typical pattern is that with each Dupuytren surgery the next recurrence of hand nodules will be a little faster than the last.

The only way to know for sure if Alternative Medicine will stimulate the natural healing process is to use a solid round of natural remedies for a month or two to determine if positive changes occur.  If successful, then the patient should consult with her physician to learn if surgery can be avoided.  If it does not help, then surgery can proceed knowing any potential risk is justified by the lack of progress with conservative methods. .

To learn about Alternative Medicine self-management, please see Different Way of Looking at Dupuytren Contracture Treatment

 

 

 

What is the difference between needle aponeurotomy and palmar fasciectomy and what are the risks?

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Needle aponeurotomy and palmar fasciectomy greatly different

Needle aponeurotomy and palmar fasciectomy are two completely different kinds of Dupuytren contracture surgery.  As with any kind of hand surgery done to release the contractures of Dupuytren disease, each has its own value, risks and limitations.  The risk and limitation of Dupuytren surgery should be considered not only because of the potential permanent consequences (numbness, reduced finger movement, reduced hand strength, reduced sensations and pain) that can occur, but also because hand surgery is not your only Dupuytren therapy option.

Alternative Medicine is a conservative and essentially risk free alternative that could make surgery unnecessary.

Dupuytren’s surgery, even when done well, can have bad unintended consequences as well as stimulate the recurrence of additional nodule and cord formation in the palm.  Since 2002 this website has suggested that anyone with Dupuytren contracture should first consider the conservative non-surgical and non-drug treatment options before attempting irreversible surgery.  To learn about Alternative Medicine self-management, please see Different Way of Looking at Dupuytren Contracture Treatment

What is a needle aponeurotomy?

Needle aponeurotomy, also called palmar fasciotomy, is considered minimally invasive Dupuytren hand surgery since a scalpel is not used to open the skin of the palm.

Needle aponeurotomy is performed by inserting a hypodermic needle into the palm of the hand with the intention to move the needle tip in a variety of directions to cut, tear and weaken the offending cords and contractures in the palm.  Without being able to see the collagen structures he is slashing with the needle tip, the surgeon blindly attempts to destabilize and release those same cords and fascial contractures that prevent full straightening of the involved fingers.

Because these structures cannot be seen as the needle moves, the risk is that nearby nerves, blood vessels and tendons might be accidentally injured or destroyed

What is a palmar fasciectomy?

There are several types or palmar fasciectomy, depending on how much tissue is removed during this type of hand surgery.  Let us begin with the words, palmar fasciectomy.

Palmar refers to the palm of the hand. Fasciectomy refers to a kind of surgery performed on fascia.  Fascia is the thin, white, tough layer of soft tissue that covers, surrounds and lines all organs, structures, tissues and cavities of the body. You can think of fascia like the clear plastic Saran wrap used to cover and protect food.  When you look in the meat case at the butcher shop you can see all kinds of fascia in the cheaper grades of roasts and steaks.   Because hands need extra support and protection from the heavy work they do, there is normally much fascia in the palm.

The ending “-ectomy” means that the surgery is done through an opening in the skin and something is removed – in this case fascia.   So, a palmar fasciectomy is a surgery on the palm during which fascia is removed.

As an interesting aside the reader will note, above, that needle aponeurotomy was noted to also be called a palmar fasciotomy.  The ending, “-otomy” means that the surgery is done to cut into the body but nothing is removed, not even the fascia. A common “-otomy” surgery is a tracheotomy in which a hole is placed in the trachea, so that breathing can take place through the opening, and noting is removed.  So, a palmar fasciotomy is a surgery on the palm during which no fascia is removed.

Not all palmar fasciectomy is performed the same. The type and extent of a palmar fasciectomy is determined by the patient’s history of previous hand injury and surgical treatment, occupation, age, family genetics and family history of the Dupuytren’s contracture, severity and location of contracture, degree of disability, and general health status.

Different types of this Dupuytren surgery include a complete palmar fasciectomy (rarely done because of typically bad results after such large tissue removal), partial or selective palmar fasciectomy, fasciectomy with skin grafting, and amputation.