Dupuytren's disease
Overview of the treatment
The most important facts
OP duration: approx. 45 minutes
Anesthesia: local anesthesia
Dressing: Change dressing on the following day, followed by regular wound monitoring
When is surgery useful?
a pronounced extension deficit exists – usually totaling about 90° across the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints of the affected finger.
the limited ability to extend significantly impairs the function of the hand and the right time for a surgical intervention has been reached.
in special cases, full extension capability is required even earlier – for example, in musicians or for comparable professional requirements.
Important: In the case of Dupuytren's disease, surgery should not be performed too early. Since the condition is prone to recurrence, an unnecessarily high number of interventions could otherwise become required over the course of a lifetime. The optimal time for surgery is therefore determined individually based on findings and functional impairment.
Methods & Variants
Partial Fasciectomy (Standard)
The diseased cord is specifically removed via a zigzag incision. The procedure is more complex than the needle technique, but has the lowest recurrence rate and can be performed safely even in advanced cases.
Needle Fasciotomy – the quick solution
The cord is severed through the skin with a needle, without a skin incision. The procedure takes only a few minutes and the hand is immediately ready for use again – however, the recurrence rate is significantly higher than with open surgery.
Conservative Options
There is no causal conservative treatment. As long as the hand lies flat and function is not restricted, waiting is the right decision – nodules alone are not a reason for surgery.
When a major intervention is necessary
In cases of recurrence, very advanced flexion contracture, or involvement of the proximal interphalangeal joints, an extensive fasciectomy with skin flap transposition may be required. We will discuss this in detail beforehand.
Dupuytren's disease is not curable, but it is highly treatable. The right timing is crucial: operating too early offers no benefit, while operating too late makes full extension more difficult.
Process – Step by Step
Diagnosis & Consultation
Dupuytren's disease is diagnosed on sight: nodules and cords are easily palpable, and the table test demonstrates the functional limitation. We also measure the extension deficit of the affected joints – this determines whether and when surgery should be performed.
Preparation
No unnecessary aspirin or ASA ten days before the operation – if there is an important reason, please continue taking it. You can fill out the medical consultation forms in advance and bring them with you.
The Procedure
The operation is performed on an outpatient basis under local anesthesia and takes about 45 minutes depending on the extent. The diseased cord is removed, while the flexor tendons and the neurovascular bundles are carefully preserved. Billing is processed through statutory or private insurance – with no co-payment.
Follow-up Treatment
The first dressing change takes place the following day. Early mobilization then begins: the fingers are moved from the very start, often accompanied by occupational therapy and a night-time extension splint. The sutures are removed after about two weeks.
Healing process
After one day, the first dressing change takes place – the fingers are actively moved from now on.
After two weeks, the sutures are removed; office work is usually possible again after just a few days.
After six weeks, firm gripping is also possible again.
After three to six months, scar induration and swelling have largely subsided.
Risks & Safety
During the first few days, swelling, bruising, and a feeling of tension are possible; temporary sensory disturbances can occur. Rarely, wound healing disorders or inflammation occur – the skin over the cord is often thin and sensitive. Scar discomfort or temporary restriction of finger movement are also possible.
We minimize risks through careful preparation of the neurovascular bundles, working under local anesthesia without anesthesia risks, a tissue-sparing incision technique, standardized hygiene processes, and early, guided exercise. Move your fingers right from the start – this is your most important contribution to the result. If swelling increases, severe redness occurs, or you develop a fever, please contact us immediately.
Diagnostics & Alternatives
Palpation and table top test, measurement of the extension deficit to confirm diagnosis and stage
Watchful waiting as long as the hand can be placed flat
Needle fasciotomy for isolated cords and when rapid recovery is desired – partial fasciectomy for pronounced findings
Extensive fasciectomy in case of recurrence or involvement of the proximal interphalangeal joints
