Perioperative management - Partial Fasciectomy for Dupuytren's Disease

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

• Local or general conditions that surgically or anesthesiologically contraindicate an elective operation or that can be improved 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 outpatient procedure
• Clarification of contraindications for exsanguination (e.g. existing shunt in dialysis)

Informed consent about

• surgical method
• extension procedure such as e.g. reconstruction artery/nerve, skin graft

• general surgical risks
  • wound healing disorder
  • tendon injury
  • functional deficit 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
  • protracted scar pain (usually subsides after 6 months)

• Plexus anesthesia
• General anesthesia

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

• The surgeon should sit on the side where the dominant hand with the scissor tip points distally
• An assistant sits opposite if necessary
• The scrub nurse positions themselves at the head end of the hand table

• The application of an upper arm tourniquet is recommended
• The use of magnifying optics such as loupes is recommended
• A hand fixation system is helpful (here lead hand)
• A hand instrument set is used, possibly microinstrumentation 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 posttraumatic pain.
• If necessary, application of cold packs as a local physical measure.

Medical Follow-up Treatment

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

Thrombosis Prophylaxis

• not applicable

Mobilization 

• immediately

Physiotherapy

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

Diet Build-up

• not applicable

Stool Regulation

• not applicable

Incapacity for Work

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