Dupuytren’s Disease: needle aponeurotomy procedure
This leaflet provides information with regards to the care of your hand following your surgical procedure to correct Dupuytren’s contracture using a needle aponeurotomy technique, also known as a fasciotomy.
What is a needle fasciotomy procedure?
During the procedure, a very fine needle will be inserted into the fibrous bands in the palm of your hand or your fingers. The needle will be used to divide the cord under your skin.
By dividing the thickened tissue, your surgeon will release the tightness in your hand that is forcing your finger to bend.
What are the benefits to having the procedure?
The benefits of needle fasciotomy include:
- your fingers are less deformed
• you recover more quickly compared to more extensive surgery - it has a low risk of complications (around 1%).
Needle aponeurotomy can be suitable for older patients who are unsuitable for surgery or if the contracture is only affecting the knuckle joint.
Will the condition recur?
The rate of recurrence for Dupuytren’s contracture is high: as many as 60% of people (or six in every 10 people) who have a needle fasciotomy experience Dupuytren’s contracture again within three to five years. The patients have to be selected carefully to get the best outcome.
What are the risks and possible complications from the procedure?
Complications, as with any surgery can occur, but with Dupuytren’s contracture they tend to be relatively mild, if they do occur at all. Complications can include:
- incomplete correction – it may not be possible to fully straighten the finger, particularly if the finger has been bent for a number of years
- delayed wound healing or infection – a small number of patients may develop an infection and may need antibiotics or very rarely a wash out procedure (more common in patients with diabetes)
- nerve injury – the contracted tissue is wrapped around the small nerves in the finger, and a small proportion of patients (five to 10 in every 100 patients) may be left with some permanent or temporary loss of feeling along the finger
- collection of blood or blood clots in the hand tissues (haematoma) – this may need a second surgical procedure to remove the blood clot
- recurrence – Dupuytrens is a disease and the flexion deformity can affect any of the fingers leading to further surgery, but the majority of patients will not need further surgery to an operated finger
- complex regional pain syndrome – this is a rare condition but can cause severe pain, swelling, and stiffness in the hand which can take several months to improve or may even persist.
Despite the list of complications and risks, please remember that the vast majority of patients have an uncomplicated routine procedure with very satisfactory recovery and outcome.
How do I care for my hand after the procedure?
After the procedure, the small wound will be covered with a sticky plaster and a bandage applied over this. You must keep your dressings dry. It is important to keep your hand elevated as much as possible for the first one to two days after the procedure to reduce any swelling.
After the first two days remove the outer bandage leaving the sticky plaster in place for a further seven to 10 days. At that time, when the wound is completely dry and scabbed over, you may wash your hand under a running tap.
What should I do if I experience pain at home?
You may be in a little discomfort and have some bruising after your procedure and this is quite normal. You may take simple painkillers such as paracetamol if you feel it necessary and you are able to take this kind of medication.
However, if you experience a large increase in pain after discharge home, and certainly if you start to feel unwell in yourself, you should contact your GP for advice regarding further management and pain relief. If this is outside GP hours then you can present yourself to your nearest minor injuries unit or accident and emergency (A&E) department. They may need to check the wound and can then advice on further management.
How do I care for my scar?
Once a scar has formed, it may become sensitive to touch during the healing phase. Therefore it is very important to massage the scar with a small amount of water based hand cream for up to eight weeks after the procedure. This will help to soften the scar tissue and reduce any sensitivity.
Will I need a follow-up appointment?
Most people do not need an appointment following a needle fasciotomy procedure. This will be discussed with you by your surgical team. Details of who to contact in the event of a problem can be found below.
How soon after surgery can I drive?
You can drive as soon as you feel confident enough to control your car safely and you are not in any discomfort. This is usually about a week after the procedure.
When can I return to my normal activities?
You should return to normal everyday activities as your pain allows, often around a week after the procedure.
When can I return to work?
Return to work depends on the type of work you do. Someone who does heavy manual work may not be able to return for a few weeks. An office worker may be able to return to light duties a few days after having the procedure. The same applies to sport and the type of sport you play.
What if I have any questions or concerns?
If you have any questions or concerns following your surgery please call the Hand Therapy Service on 01227 783043 and leave a message on the answer phone stating your patient number. We will try to return your call within 24 hours (Monday to Friday).