Dupuytren's Contracture Hand Surgery
Reconstructive plastic surgeon Murray Beagley has a particular interest in treating Dupuytren’s disease of the hand having performed well over a thousand hand surgeries for this condition.
Dupuytren's is a progressive disorder involving the fibrous tissues in the palm of the hand which leads to lumps and nodular swellings in the hands which then can go on to cause contractures of the digits. These contractures can cause the little and ring fingers in particular to curl up and become fixed in a bent position.
There are no clear reasons why Dupuytren’s occurs however it is more common in people of Celtic origin or in those with a family history of the disorder.
Treatment of the condition is primarily surgical which involves removal of the diseased fascia and correction of the bent joints. The improvement gained at surgery is largely dependent on the extent of the disease, how long the disorder has been present and the experience of the surgeon in dealing with this sort of problem.
In severe conditions, in younger patients or in recurrent cases, not only is the surgery more difficult but also requires the use of skin grafts to ensure healing and lessen the chance of recurrence.
Dupuytren's Surgery Procedure
Dupuytren’s surgery is performed under an arm block (where your arm is fully anaesthetised while you remain awake) or more usually under a full general anaesthetic (where you are asleep). The surgery takes between 90 mins and 2 hours or longer if multiple fingers are involved or in recurrent disease states.
The Risks of Hand Surgery
There is a small but real risk of injury to nerves and blood supply to the digits as the diseased tissue becomes intertwined amongst the vital structures supplying the digits. As with any surgery there are also risks of infection, skin loss, delayed healing, graft loss, incomplete correction and recurrence.
Mr Beagley has extensive experience in complex hand surgery and offers a high standard of care to all his patients. The incidence of these risks can be discussed with you at your consultation. Revision surgery carries a slightly higher risk for almost any complication.
Post Hand Surgery
Following surgery you will be in a splint which stays in place for a week. If you do not have a graft in place you will see a Hand Therapist who will begin mobilisation of your hand at a week.
If you have a graft, the dressing is changed by me or my nurse at one week. You are then put back in the splint for a further week until the graft has fully taken. At that stage you will be seen by a Hand Therapist to commence mobilisation of your hand. The sutures placed in the hand to close the wounds are dissolvable and do not normally require formal removal.
Occasionally, when the joints are very bent, prior to surgery a wire is needed to be passed across the joint to hold the finger in its corrected position. This wire is removed at one week.
Regaining the use of your hand is a gradual process and is dependent on the degree of deformity prior to surgery and the extent of surgery required to correct the condition. Generally speaking, expect 4-6 weeks of rehabilitation before you are able to use your hand for day to day activities.
