Complications - Partial fasciectomy for Dupuytren's disease

• Nerve injury
• Circulatory disorder

Management in case of intraoperative complication

• primary microsurgical nerve suture
• in case of vascular spasm, local measures with warm moist compresses, possibly lidocaine
• in case of arterial injury, microsurgical revision (simple suture, possibly vein graft)

Acute Complications

• Bleeding/Hematoma
• Infection/Wound healing disorder
• Skin flap necrosis

Management

• In case of significant hematoma, surgical revision
• In case of infection, immediate surgical revision
• In case of wound healing disorder, surgical revision depending on severity, possibly skin graft

Late Complications

• Recurrence
• Scar contracture
• Circulatory disorder
• Sensory disturbance
• CRPS (Sudeck's disease)

Management

Each additional surgery carries higher risks for circulatory disorder and/or sensory loss. In severe cases, this can lead to the loss of the finger!

Therefore:

• Critically evaluate reoperation, at the earliest after scar maturation (1 year). Proper patient education is mandatory!
• In case of scar pain/neuroma pain/neuropathic pain, adopt a wait-and-see approach, possibly desensitization therapy
• In case of scar contracture, wait for scar maturation, possibly Z-plasty
• In case of neurodesis pain with adhesions, neurolysis, microsurgical reconstruction. Last resort: neuroma resection
• In case of CRPS, appropriate treatment of the condition (see literature)