Open Surgery
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.
Preoperative Contracture
Postop One Week