Potential side effects of hand surgery (fasciectomy)

Surgery in general can have several side effects, but here we will focus on the ones related to Dupuytren's disease specifically. Our list here might not be complete and, while the actual side effects in individual cases are hard to predict, many patients experience just light side effects. Yet in unfavourable cases the hand might even be in a worse condition after the surgery. One thing is for sure: the hand is very delicate to operate on because tendons, nerves, muscles, and other important parts are very, very close together. It requires a skilful, experienced hand surgeon to cut into a hand, clean all Dupuytren's fibres, and not do any damage elsewhere. We recommend that you select your surgeon carefully.

Side effects are unfortunately not unlikely: "The survey of 990 operations by McFarlane (1983) in a multi-centric study, best illustrates the frequency of serious complications following today's most popular operations: an overall complication rate of 19% and loss of flexion and algo-neuro-dystrophy occurring alone or together in 10% of patients." (cited from Thesis Moermans, 1997). More recently an overview of Early Postoperative Complications was compiled by Keith Denkler "Surgical Complications Associated With Fasciectomy for Dupuytren's Disease: A 20-Year Review of the English Literature" full_text.

Possible side effects of which we have heard (or experienced ourselves) include:

  • "The most common complications are postoperative joint stiffness and loss of preoperative flexion, further emphasizing the importance of a postoperative rehabilitation program." source: e-medicine-Revis. Good rehab after Dupuytren surgery is important. It makes sense to inquire about available rehab capabilities prior to deciding where to have surgery.
  • "Other complications may include hematoma, skin loss, infection, nerve injury, vascular injury, prolonged edema, and reflex sympathetic dystrophy." Source: e-medicine-Revis.
  • "Significant hand arthritis is a relative contraindication to surgery because these patients are at an extremely high risk of worsened hand function after surgery." Source: e-medicine-Revis.
  • generally don't expect this surgery to be a minor cut that heals quickly. It is likely that your hand will have to be opened to quite some degree. This will result in wounds and pain afterwards and will take several weeks to heal.
  • don't expect your hand to be usable as normal very shortly after the surgery. Rather expect 2 - 6 months until your hand is fully operational, and you can, for example, carry heavy weights again.
  • even when everything goes well with your surgery, it is possible that you are able to use your hand afterwards for carrying things, playing tennis, type on keyboards etc., but finer arts might continue to be difficult or be even more difficult than before the surgery. That may include handwriting, fine crafting, playing music instruments or even holding things securely.
  • it is possible that some stiffness of the tendons will remain permanently and that you can straighten your fingers but have difficulties and pain when making a fist.
  • there is a fair chance that Dupuytren's disease will come back (this is called recurrence) and you might need more surgery. Typically those repeated surgeries are more difficult and probably less successful, unfortunately.
  • there is some indication that damage to the hand can trigger Dupuytren's disease. Surgery can be viewed as a sort of damage. And we know of a case where a patient had surgery on a single finger and then experienced within a couple of months after the surgery an outbreak of Dupuytren on six other locations, including the other (not operated upon) hand. Possibly Dupuytren already existed there in a hidden, dormant form and was triggered by the healing process. Although this is possibly not a frequent side effect, it obviously can happen, a sort of worst case scenario. An example, including repetitive surgery, was provided by a patient history_stefan_h. A British patient describes his experience with surgery, side effects and disease extension in detail on surgery_dupuytrens. Another patient summarized in our forum "It would appear in my case the first surgery started the clock ticking for the next surgery with the time span between surgery becoming shorter and shorter, and the outcome reducing because of scar tissue."

Actually some of the above side effects may be predictable. A paper by A. Wilhelm and D. Englert on "The Significance of the Subclavian Vein Stenosis in the Treatment of Dupuytren's Disease" (Handchir. Mikrochir. Plast. Chir. 21 (1989) p 66 - 71, English abstract, full paper in German) demonstrates that constricted veins (stenosis) of the arm can severely affect the healing process after operation. This can result in edema or a hand-finger-syndrome, including the inability to make a fist. 

Histological staging might help predicting recurrence and extension of the disease after surgery, see T. Belaguer at al. "Histological Staging And Dupuytren's Disease Recurrence or Extension after Surgical Treatment: A Retrospective Study of 124 Patients" J Hand Surg. Eur. 2009 Apr 24. Abstract More recently O Donaldson, winner of the Dupuytren Award 2011, analysed “The association between intraoperative correction of Dupuytren's disease and residual postoperative contractureThe Journal of Hand Surgery (European Volume, 2010) 35E: 3: 220–223 abstract.

 

Post-Op treatment

Many clinics and patients consider physiotherapy after surgery as important for a good recovery. Unfortunately no standards exist and little has been researched in this aera. We suggest to discuss and plan for good post-surgery rehab before undergoing surgery.

It might be worth noting that a comparison of a postoperatively treated group of patients with a not treated group did not reveal significant differences. H. Herweijer et al. "Postoperative hand therapy in Dupuytren's disease" (Disabil Rehabil. 2007 Nov 30;29(22):1736-41 abstract). "Given the lack of differences in outcomes between patients correctly referred and patients incorrectly not referred, postoperative hand therapy in Dupuytren's disease should be reconsidered."


Page last modified: 01/11/2017