Recovery after Dupuytren's contracture treatment and hand therapy

The NHS describes needle fasciotomy, fasciectomy and dermofasciectomy. Needle fasciotomy is done through the skin with needle punctures under local anaesthetic and can allow same-day discharge. Fasciectomy involves an incision to remove affected tissue, again with same-day discharge possible. Dermofasciectomy adds skin grafting and involves two separate procedures.

Recovery tracks the amount of tissue disturbed. A needle procedure leaves no surgical wound to heal, so the NHS gives up to two weeks. An open operation leaves a wound and scar, and the NHS gives 4 to 12 weeks for fasciectomy. For dermofasciectomy the NHS pages used here do not state a duration.

The NHS says the specialist will explain what to expect afterwards, including advice on exercises. The pages used here do not describe splinting regimes or therapy schedules, so they cannot be set out here, and units differ in how they use splints and therapists.

In general the goals of aftercare are to keep the new finger movement, protect the wound or graft, control swelling, soften the scar and rebuild grip. A hand therapist, usually a physiotherapist or occupational therapist with additional hand training, may supervise this. Follow the plan from the unit that treated you, because it is tailored to the technique they used.

• Ask whether a splint is advised, and when and for how long.

• Ask which exercises to start, and how often.

• Ask how to care for the wound, graft or needle sites.

• Ask what to do if the finger starts to curl again.

After needle fasciotomy the early period is short, and the NHS gives up to two weeks for recovery. After fasciectomy or dermofasciectomy, the hand may be bandaged or splinted and swelling and tenderness are expected. The exact instructions depend on the surgeon.

Contact the unit or use NHS 111 for signs of infection such as spreading redness, heat, discharge or fever, severe pain, a finger that turns pale, cold or blue, or new numbness. The NHS lists bleeding and numbness among possible complications of fasciectomy.

The NHS says fasciectomy recovery takes 4 to 12 weeks, a wide range because it depends on how much tissue was removed, how many fingers were involved, and how the wound heals. Many people find the hand is functionally useful sooner than it feels completely normal.

The NHS is clear that the finger may not be completely straight and may not be as strong or flexible as it used to be. Joints that were bent for a long time before treatment, especially the middle finger joint, may straighten less completely than the knuckle joint.

The NHS says the contracture can return after several years, whichever treatment is used. It describes fasciectomy as having the lowest recurrence risk, needle fasciotomy a higher recurrence rate than surgery, and dermofasciectomy a lower chance of recurrence than standard fasciectomy. The pages used here give no percentages.

If the finger starts to bend again, it is usually reasonable to ask for review before it becomes marked, because earlier treatment options may be simpler. Treating the same finger again is a discussion with the hand surgeon.

The pages used here give no date for driving or work. Because the timeline ranges from up to two weeks for needle fasciotomy to 4 to 12 weeks for fasciectomy, practical questions are best answered by your own unit, based on what was done and the demands of your job or hobbies.

People who use their hands for gripping tools, playing instruments or sport are worth mentioning to the therapist, since graded return to those tasks forms part of rehabilitation.