Fasciectomy for Dupuytren's Contracture: What to Expect at Home

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Your Recovery

Fasciectomy (say "fash-ee-EK-tuh-mee") is surgery to cut out a layer of tissue called the fascia (say "FASH-ee-uh") that lies deep under the skin. In Dupuytren's (say "duh-pwee-TRAHNZ") contracture, the fascia of the palm of the hand becomes thick and tight. This causes the fingers to become stiff and to curl toward the palm. Removing the fascia can help relax the fingers.

Your hand and fingers may be swollen for the first few days. Most people need pain medicine for about a week after surgery. You may feel numbness or tingling near the cut, called an incision, that the doctor made. This feeling will probably start to get better in a few days, but it may take several months to go away. Your doctor will take out your stitches about 2 weeks after your surgery.

How soon you can return to work depends on your job. If you can do your job without using the hand, you may be able to go back in 1 to 2 weeks. But if your job requires you to do repeated finger movements, put pressure on your hand, or lift things, you may need to take 6 to 12 weeks off work. Your doctor can help you decide how much time you will need to take off work.

An important part of recovery is hand therapy. Work with your physiotherapist or occupational therapist and practice hand exercises at home to help your fingers become more flexible. Hand therapy may also help prevent future problems. Most people need to do hand therapy for several months. You also may need to wear a hand splint for 6 to 12 weeks after surgery.

After surgery and hand therapy, your hand and fingers should be more flexible. Many people get better without any problems. But it is possible that the fascia may become thick and tight again. Even if this problem comes back, it is usually not severe enough that another surgery is needed.

This care sheet gives you a general idea about how long it will take for you to recover. But each person recovers at a different pace. Follow the steps below to get better as quickly as possible.

How can you care for yourself at home?

Activity

  • Rest when you feel tired. Getting enough sleep will help you recover.
  • Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk.
  • Do not use your hand until after the incision has healed, usually about 2 weeks after surgery. This includes lifting things heavier than 0.5 to 1 kilogram or doing repeated finger or hand movements, such as typing, using a computer mouse, washing windows, vacuuming, or chopping food. Do not use power tools, and avoid other activities that make your hand vibrate. Your doctor or physiotherapist or occupational therapist will tell you when it is okay to use your hand again.
  • Ask your doctor when you can drive again.
  • You will probably need to take at least 1 to 2 weeks off from work. It depends on the type of work you do and how you feel.
  • You may shower, but do not get your hand wet until your doctor says it is okay. Keep the bandage dry by covering it with plastic. Do not take a bath, swim, use a hot tub, or soak your hand until your doctor says it is okay.

Diet

  • You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.

Medicines

  • Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines.
  • If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, be sure to talk to your doctor. He or she will tell you if and when to start taking those medicines again. Make sure that you understand exactly what your doctor wants you to do.
  • Take pain medicines exactly as directed.
    • If the doctor gave you a prescription medicine for pain, take it as prescribed.
    • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • If you think your pain medicine is making you sick to your stomach:
    • Take your medicine after meals (unless your doctor has told you not to).
    • Ask your doctor for a different pain medicine.
  • If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

  • Leave the bandage on your hand until the doctor says it is okay to remove it. This is usually 2 or 3 days after surgery.
  • After the doctor says you can take off your bandage, wash the area daily with warm, soapy water, and pat it dry. Don't use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
  • Keep the area clean and dry.

Exercise

  • Gently bend and straighten your fingers throughout the day to keep them flexible and to help reduce swelling.
  • Do your hand therapy as directed by your doctor or physiotherapist or occupational therapist. This can help you regain flexibility and strength in your hand and fingers. To get the best results, you need to do the exercises correctly and as often and as long as your doctor or physiotherapist or occupational therapist tells you to.

Ice and elevation

  • Put ice or a cold pack on your hand and wrist for 10 to 20 minutes at a time. Try to do this every 1 to 2 hours for the next 3 days (when you are awake) or until the swelling goes down. Put a thin cloth between the ice and your skin.
  • Prop up your hand on a pillow anytime you sit or lie down during the first 2 or 3 days after surgery. Try to keep the hand above the level of your heart. This will help reduce swelling.
  • Wear a sling to support your hand, if your doctor tells you to. Make sure to move your arm and shoulder often if you wear a sling. This will help prevent your elbow and shoulder from getting stiff.

Other instructions

  • For the first day or two after surgery, you may have a tube near your incision to drain fluids. Your doctor will tell you how to take care of it.
  • Wear your hand splint as directed by your doctor.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

  • You passed out (lost consciousness).
  • You have severe trouble breathing.
  • You have sudden chest pain and shortness of breath, or you cough up blood.

Call your doctor or nurse call line now or seek immediate medical care if:

  • You have pain that does not get better after you take pain medicine.
  • You have loose stitches, or your incision comes open.
  • Your incision bleeds through a large bandage.
  • You have signs of infection, such as:
    • Increased pain, swelling, warmth, or redness.
    • Red streaks leading from the incision.
    • Pus draining from the incision.
    • Swollen lymph nodes in your neck, armpits, or groin.
    • A fever.
  • Your hand or fingers are cool or pale or change colour.
  • You have tingling or numbness in your hand or fingers.
  • You cannot move your fingers.

Watch closely for any changes in your health, and be sure to contact your doctor or nurse call line if:

  • You are not getting better as expected.

Where can you learn more?

Go to http://www.healthwise.net/ed

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