I am a tad nervous. This hand surgeon/plastics guy has done this a lot. I am on medi-cal and am an artist and have waited for 7 years since chemo seems to have started this. What I am concerned with is my lack of lymph nodes in that arm where surgery is going to be done. I have not had lymphodema, and the doc said O well u may want to think about this. Then He suggested using a tourniquet.
Any advice?

Hi, Claire316

I don't normally jump in for medical advice, but this is an issue which is discussed with interest by hand surgeons because conflicting recommendations exist. On one hand, there is a common recommendation from medical doctors to avoid doing anything to a hand which has had a lymph node dissection: no shots, blood draws, blood pressure measurements, tourniquet. On the other hand, people do develop problems which require surgery on hands which have had prior lymph node dissections, and hand surgery is usually done with the help of a tourniquet during surgery. These people seem to be caught in the middle. However, based on experience and several published reports, it appears to be safe to do surgery with a tourniquet on a hand which has a lymph node dissection.

Here is what I think is the back story on this. Surgeons began doing radical lymph node dissections long before antibiotics were discovered. Staph and Strep infections were problems, and before penicillin, if you got a bad Strep infection, you had a good chance of dying. The catch is that poor lymph drainage increases the risk of Strep infections. So there were patients who had lymph node dissections, and if surgery or a later minor injury led to a Strep infection, they ran a real risk of dying from the Strep infection. This was an impressive enough series of events that it became standard recommendation to recommend extraordinary caution after lymph node dissection, and these recommendations continued after penicillin and better antiseptic techniques were developed.

With current sterile technique and antibiotics during surgery, this scenario no longer applies. Hand surgery using a tourniquet appears to be as safe with lymph node dissection as with normal lymph nodes. "Safe" is statistically low risk, not 100% guarantee. After surgery, prior lymph node dissection makes it even more important to elevate the hand and avoid constricting bandages or clothing around the arm.

Either open hand surgery or needle release are reasonable considerations for Dupuytren's after lymph node dissection. I suspect that collagenase would not be recommended because it results in lymph node irritation in normal patients and I don't think that there is experience yet with its use after lymph node dissection.

Good luck!

Charles Eaton MD