Complications - Partial Fasciectomy for Dupuytren's Disease

• Nerve injury
• Perfusion disorder

Management of intraoperative complication

• primary microsurgical nerve suture
• for vascular spasm local measures with warm moist compresses, if necessary lidocaine
• for arterial injury microsurgical revision (simple suture, if necessary vein graft)

Acute Complications

• Bleeding/Hematoma
• Infection/Wound Healing Disorder
• Skin Flap Necrosis

Management

• In case of relevant hematoma, surgical revision
• In case of infection, immediate surgical revision
• In case of wound healing disorder, surgical revision according to severity of findings, possibly skin graft

Late Complications

• Recurrence
• Scar Contracture
• Perfusion Disorder
• Sensitivity Disorder
• CRPS (Sudeck's Disease)

Management

Every further operation carries higher risks for a perfusion disorder and/or loss of sensation. This can in serious cases lead to the loss of the finger!

Therefore:

• Critically review reoperation, at the earliest after completion of scar maturation (1 year). Corresponding patient education mandatory!
• In case of scar pain/neuroma pain/neuropathic pain, watchful waiting, possibly desensitization therapy
• In case of scar contracture, wait for scar maturation, possibly Z-plasty
• In case of neuroma pain with adhesions, neurolysis, microsurgical reconstruction. Ultima ratio: Neuroma resection
• In case of CRPS, appropriate therapy of the disease (see specialist literature)