Traditional open surgery for Dupuytren’s contracture is also called fasciectomy.
This technique has been performed with different variations since the 1800’s. The
principle is quite simple. Bad stuff grows in the hand and creates the contractures.
Cut open the hand, and remove the bad stuff! While not quite that simple, that
is the idea.
Many technical variations exist on how to perform this type of surgery, but all have
same principles in mind:
Remove the diseased tissue
Preserve the important normal anatomy (nerves, blood vessels, etc…)
Repair the wound in such a way that it heals without excessive scarring.
Because of the potentially extensive and diffuse nature of the contracture cords,
this is an operation typically only performed by experienced hand surgeons. The
challenge of the operation is to remove as much diseased tissue as possible by untangling
it from the surrounding critical nerves and blood vessels. I tell patients that
it is much like trying to untangle two vines in the garden; one is a weed, and the
other a delicate flower. The vines often appear similar in color and texture, and
can be quite intertwined.
The surgery can typically take 45 minutes to 2 hours, but it is an outpatient procedure.
The hand is heavily bandaged and splinted for a week. Pain is usually not excessive,
and therapy can begin shortly afterwards.
There certainly is a greater post-operative downtime than the other less invasive
procedures. The open technique is a better option in some patients with contractures
that are not amenable to other methods. It is also the only way to eradicate large
nodules. Furthermore, it tends to provide more lasting results.