Is this procedure always necessary?
This is a procedure designed to straighten the finger, and is something that people usually opt to do because of restriction in the function of the hand as a result of Dupuytren’s disease. The alternative methods of management are:
– Doing nothing! – this is a very reasonable alternative, because Dupuytren’s disease is a benign and harmless condition.
– Fasciectomy – This is an operation to remove the diseased tissue from the finger and allow it to straighten. It is a much bigger operation than needle fasciotomy, and is usually recommended in more severe disease.
– Dermofasciectomy – Again, this operation is the biggest operation we do to remove the Dupuytren’s tissue and overlying skin. This operation takes a long time to recover from, and is usually only recommended in severe disease.
What is a needle fasciotomy?
This is a way of treating early Dupuytren’s disease by dividing a section of the thickened tissue that is causing the finger to curl towards the palm. It does not remove the Dupuytren’s tissue but rather gives a partial release of the bent finger. This is usually sufficient to improve your hand function and is suitable for early disease as seen in the photographs below.
What happens on the day of surgery?
On the day of the operation, you will be asked to report to the Day Surgery Unit at the Queen Margaret Hospital. Watch our introductory video here. You can expect to be in hospital for anything between 2 and 6 hours, depending on the list order. Please be aware that the hospital has a strong recommendation that you do not drive yourself home immediately after a needle fasciotomy procedure.
Your hand will be assessed by the surgeon, who will check that a needle fasciotomy is an appropriate treatment – sometimes we get this wrong and a bigger operation is needed to deal with the disease – unfortunately we do not have the resources available on this list to change the decision at the last minute, so any surgery has to be rescheduled
What should you do to prepare?
The admission pack we send you contains a document called ‘Having an operation on your hand or arm‘. You can access this online by clicking here. This runs through most of the risks involved with the surgery, and it is really important that you are aware of this risk before agreeing to the surgery. It is important to remove all jewellery from your hand and wrists.
Planning for when you get home is also important. Although there are no restrictions on how you use your hand after the surgery, your hand may not work the way you want it to in the first few weeks after the operation and you may be a bit sore. This will settle.
What type of anaesthetic is used?
Needle fasciotomy is done under local anaesthetic, using a technique called WALANT surgery. The local anaesthetic usually lasts a few hours, then slowly wears off.
The anaesthetic is put in using a very fine needle in the anaesthetic room around the area of Dupuytren’s disease. The anaesthetic is designed only to numb the area of the operation and not the whole hand. Injection of the anaesthesia will feel uncomfortable and sting for about 30 seconds but following this you should not feel anything sharp. You will however, feel pressure.
What exactly does the surgeon do?
The surgeon’s job is to divide the the thickened band or cord in the ligament which is causing the finger to curl towards the palm. This is done by using the sharp edge of a needle to break the cord under the skin.The idea is that this allows some correction of the finger, that is, it becomes straighter. Often, multiple needle fasciotomies need to be performed at different levels along the tight band to try and achieve a straighter finger. This is done at under the same anaesthetic.
At the end of the operation, the surgeon will show you the degree of finger correction. You will have a small dressing over the wound.
Rehabilitation
After the procedure, you will be advised to move the hand regularly – we usually say that making a full fist and then fully straightening the fingers ten times every half and hour is about right. There are no restrictions otherwise. The needle marks should be kept dry for around 24 hours until they seal over – sometimes a little longer, but it is generally safe to soak the hand by 72 hours
Follow-up
We do not need to see you back after this procedure, unless you feel it is necessary. We will put you in charge of this decision, and if an appointment is required for any reason, you can contact us here. Click on this link to contact us.
Our Shared Care information sheet is available here.
The next time we get in touch with you is at 1 year – we will write and ask you to fill out our ‘outcome questionnaire‘ – as part of our hand audit. Please do fill this out for us, because it helps us to improve the service for patients.
Are there any complications to needle fasciotomy?
There are several complications associated with this type of surgery –
1) Skin tear – Where the disease is very adherent to the overlying skin, the skin may tear when the finger straightens. this can range from a tiny tear of 2-3 mm, up to a tear of a few centimetres. Skin tears heal quickly, and although they need to be covered, they rarely affect the result of the surgery. A skin tear happens in around 1 in 20 patients.
2) Infection – Infection is a complication of all operations. Luckily, it is very rare in needle fasciotomy, but can still occur.
3) Damage to nerves – Using a needle under the skin can damage the nerve to the finger. This is unusual, and the surgeon will generally avoid placing the needle near any nerves, but remains a risk, particularly in more severe disease.
4) Damage to the arteries of the finger – The needle used can damage the tiny artery to a finger. This can cause quite heavy bleeding from the needle wound but is not usually a problem once bleeding stops.
5) Tendon damage – Once again, tendons can be damaged by the needle. This complication is rare, but will prevent the finger bending normally if it occurs.
6) Stiffness – It is usually very safe to mobilise the hand straight away, but sometimes stiffness sets in if the hand is not moved regularly.
7) Recurrence – There is, as yet, no cure for Dupuytren’s disease and despite any release, it is likely to recur over the course of a few years. It is a benign condition, however, and can be safely left untreated.
Other general complications of surgery are outlined in our information sheet, Having an operation.
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