Francois J Duminy

PLASTIC & RECONSTRUCTIVE SURGEON

Du Puytren's Surgery

There are many methods for releasing and or removing DuPuytren's contractures

One method involves cutting accross all the bands, leaving the wound open and allowing it to slowly heal while keeping the hand splinted so that the fingers remain extended!

Our own practice has always been as follows:

  • The Anaesthetist gives conscious sedation and an intravenous local anaesthetic Block (Bier's Block) to numb the forearm and the hand. The Local anaesthetic is kept in place and blood is kept out of the arm by means of a special tourniquet cuff.
     
  • We make Bruner incisions (which never cross a palmar crease perpendicularly and therefore have a zig-zag appearance). Via these incisions, we expose the fibrous bands and carefully remove them while being careful to protect nerves and vessels.
     
  • The wounds are sutured with multiple small sutures and soft dressings with compression bandages are applied to the hand.
     
  • Pre- and post-operative Physiotherapy is mandatory.
     
  • The patient is encouraged from the beginning to move the hand through a full range and the Physiotherapists and Occupational Therapists help us to maintain that range through the healing process, sometimes by exercise and sometimes by wearing splints at night.
     
  • We usually do only one hand at a time, leaving the other hand free for essential tasks.

 

Benefits experienced by most patients:

1. Improved mobility and function of the hand

2. Fingers dont get stuck in pockets

3. Handshake greetings are less awkward

Negative Aspects:

1. Pain, swelling and bruising in the first few days requires elevation of the hand

2. Scars, with good Scar Care - usually fade within a few months

3 Sensory Changes can occur especcially when straightening a finger causes a nerve to be stretched. They usually recover in a few months

4. Long recovery - 6 to 12 weeks may be required to achieve good function of the hand

5. Du Puytren's Contractures may recur after a few years