Perioperative management - Partial fasciectomy for Dupuytren's disease

• Flexion contracture of the MCP and/or PIP joint of more than 30°
• Significant limitation of hand function

• Local or general diseases that contraindicate an elective surgery surgically or anesthesiologically, or are improvable preoperatively

• Clinical Examination:
  → Inspection/Palpation of the typical Dupuytren's tissue with flexion deformity of the joint

• no special preparation of the patient necessary
• generally an outpatient procedure
• clarification of contraindication for bloodlessness (e.g., existing shunt in dialysis)

Information about

• surgical method
• additional procedures such as artery/nerve reconstruction, skin graft

• general surgical risks
  • wound healing disorder
  • tendon injury
  • functional deficit of wrist/hand
  • CRPS = Sudeck's disease

• specific surgical risks
  • injury to vessel/nerve bundle with corresponding consequences
  • skin necrosis
  • recurrence
  • activation of the disease
  • scar contracture
  • prolonged scar pain (usually subsides after 6 months)

• Plexus anesthesia
• General anesthesia

• Supine position
• Placement of the hand on a hand table
• Recommended: Application of upper arm tourniquet

• The surgeon should sit on the side where the leading hand points distally with the scissor tip
• Opposite, an assistant may sit if necessary
• The instrument nurse positions themselves at the head of the hand table

• It is recommended to apply an upper arm tourniquet
• The use of magnifying optics such as loupes is recommended
• A hand fixation system (here lead hand) is helpful
• A hand instrument set is used, possibly micro-instruments for reconstruction of vessels or nerves

Postoperative Analgesia

• Follow the link here to PROSPECT (Procedures Specific Postoperative Pain Management).
• Follow the link here to the current guideline Treatment of acute perioperative and post-traumatic pain.
• Possibly apply cold packs as a local physical measure.

Medical Aftercare

• Regular wound inspection, elastic compressive bandage (Caution: Constriction!) for a few days.
• Suture removal after 14 days

Thrombosis Prophylaxis

• not applicable

Mobilization 

• immediate

Physical Therapy

• Active exercise therapy with possible physiotherapeutic support with full extension and fist closure of the fingers from the 1st postoperative day (prevents hand edema and finger stiffness).
• Possibly splint therapy or specific scar therapy required.
• Specific hand therapeutic measures for advanced findings.

Dietary Progression

• not applicable

Bowel Regulation

• not applicable

Incapacity for Work

• Usually 14-21 days depending on manual activity (maximum 6 weeks).