 had regained full motion of the affected joint. The long-term results and recurrence rates with enzyme fasciotomy are unknown at this time.
No hard and fast rule exists as to when surgery is needed. But the sooner a contracture is treated, the better the results of a return to full function. Many patients are instructed to keep an eye on the disease and return for follow-up once their “tabletop test” shows light between their hand and the table.
Surgery is usually recommended when the MCP joint (at the knuckle) of the finger reaches 30 degrees of flexion. When patients have severe problems and require surgery at a younger age, the problem often comes back later in life. When the problem comes back or causes severe contractures, surgeons may decide to fuse the individual finger joints together. In the worst case, amputation of the finger may be needed if the contracture restricts the nerves or blood supply to the finger.
Surgery for the main knuckle of the finger (at the base of the finger) has better long-term results than when the middle finger joint is tight. Tightness is more likely to return after surgery for the middle joint.
The goal of tissue release surgery is to release the fibrous attachments between the palmar fascia and the tissues around it, thereby releasing the contracture. Once released, finger movement should be restored to normal. If the problem is not severe, it may be possible to free the contracture simply by cutting the cord under the skin.
A less invasive procedure called a needle aponeurotomy (also referred to as a percutaneous fasciotomy) is available when the disease is at an early stage. Under local anesthesia, the surgeon inserts a very thin needle under the skin. The sharp needle cuts a path through the cord, weakening it enough to stretch and extend or rupture it.
The advantage of this procedure is that it can be done on older adults who have other health issues that might make surgery under general anesthesia too risky. The disadvantage is a high recurrence rate and the potential for nerve injury, infection, and hematoma (pocket of blood) formation.
This procedure has replaced the “open fasciotomy” in many practices.
Palmar Fascia Removal (partial or limited palmar fasciectomy)
This remains the gold standard of treatment for Dupuytren's contracture. Removal of the diseased palmar fascia causing the contracture will usually give a very good result. Final outcomes depend a great deal on the success of doing the postoperative physical or occupational therapy as prescribed. If you decide to have this surgery, you must commit to doing the therapy needed to make your surgery as successful as possible.
Removal of the entire palmar fascia (radical fasciectomy) requires extensive removal of involved and non-involved palmar and digital (finger) fascia. This procedure may be required in cases of severe or recurrent Dupuytren's contracture. This approach has higher complications rates without providing better success rates so it is not done as often anymore.
Complications of a palmar fasciectomy can include permanent nerve damage, joint pain and stiffness, hematoma (pocket of blood), infections, and poor wound healing.
Surgery does not always fully restore range-of-motion and function but it usually increases the ability to extend (straighten) the affected fingers. You should also be aware that the problem can come back and/or spread. In other words, surgery is not always “curative.”
A skin graft may be needed if more extensive removal of the palmar fascia is required. This may be the case when the skin surface has contracted so much that the finger cannot relax as it should and the palm cannot be stretched out flat. Surgeons graft skin from the wrist, elbow, or groin. The skin is grafted into the area near the incision to give the finger extra mobility for movement.
Related Document: A Patient's Guide to Dupuytren's Contracture Surgery
What should I expect after treatment?
No formal physical therapy is generally needed for enzyme fasciotomy.
After a needle aponeurotomy usually physical therapy is not