What are the potential complications of surgical treatment for Dupuytren's contracture that I should discuss with my patients?

When discussing surgical treatment for Dupuytren's contracture with patients, it is important to inform them about several potential complications. These include tendon rupture, digital nerve injury, and artery injury, which can occur during surgery. Patients should also be aware of risks such as infection, ischaemia, haematoma, and wound healing problems including skin loss. Postoperative issues like finger stiffness, swelling, and pain are common, as well as a flare reaction characterized by stiffness, pain, and oedema occurring 2–3 weeks after surgery, which is more frequent in women. Complex regional pain syndrome is another serious complication, also more common in women. Incomplete correction of the contracture and disease recurrence are additional risks. The overall complication rates vary by procedure type, with needle fasciotomy having about a 19% complication rate, fasciectomy 17%, and dermofasciectomy 12%. Serious local complications within 90 days are relatively low at 1.2%, and serious systemic complications at 0.78%. However, the amputation rate after re-operation by limited fasciectomy following dermofasciectomy can be as high as 8% ¹.

These risks highlight the importance of early referral and intervention to optimize outcomes and potentially reduce the extent of surgery needed. While the UK guidelines provide these complication rates and risks, recent medico-legal evaluations emphasize the need for careful surgical indication based on best evidence to minimize harm and improve patient safety (Basile et al., 2024).