Complications
Neurovascular injury can be minimised by meticulous intraoperative dissection, identifying the nerves and arteries, and by cutting only tissue that is well visualised after the neurovascular bundles for a particular digit have been identified and retracted.
Digital neurapraxia is sometimes unavoidable when a previously contracted digit is straightened. Occasionally, digital ischaemia may occur after extension of a previously contracted digit, due to arterial stretch and vasospasm. If this occurs intraoperatively, the finger should be passively flexed and treated with warm saline. If this fails to restore blood flow, the local application of lidocaine should be considered, and if this is unsuccessful, intravenous heparin may be administered.
The risk of haematoma formation is minimised by tourniquet deflation when the fasciectomy is completed, by achieving adequate haemostasis prior to wound closure, and/or by closing the wound over a drain.[65]
Infection is countered with the use of perioperative antibiotics and careful soft tissue handling.
Complications associated with wound healing can be minimised by careful flap planning, meticulous elevation of flaps, and haematoma prevention. Reported incidence of postoperative surgical site infection is 0.04% at 90 days.[66]
Prophylaxis is difficult due to the need for a prolonged period of postoperative immobilisation after Dupuytren surgery.
Supervised hand therapy exercises should be instituted as soon as the state of the wound allows exercising of the hand.
The post-procedural recurrences reported may represent both true recurrence (disease at the operative site) and disease extension (disease outside the prior surgical area).
Recurrence is significantly more common in patients who present with proximal interphalangeal (PIP) joint contractures, a diseased little finger, or multiple affected digits, and the risk of recurrence increases with severity of the contracture.[50]
Due to the fact that diseased fascia is left behind, needle aponeurotomy is associated with a recurrence rate of at least 50% and percutaneous fasciotomy is associated with a recurrence rate of at least 43%, whereas open partial fasciectomy is associated with a postoperative recurrence rate of 15%, and segmental aponeurotomy is associated with a recurrence rate of 20% to 35%.[46][47][48]
Early warning signs of reflex sympathetic dystrophy, such as excessive postoperative pain, should be responded to with diligence and a high index of suspicion.
Postoperative dressings should be loosened or changed in the presence of severe hand or digit swelling.
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