Consent form

Information letter

What to bring

 

Consent form

The consent form sets out the procedure, the reason for the procedure and the common or serious risks of the procedure.  It is a legal document and you will have to sign it prior to undergoing treatment.  The information is scary! The reason is to make sure that you understand that this is, despite its apparently minor nature, a surgical operation.  You will have ample opportunity to discuss the information prior to surgery.

Operation

Needle Aponeurotomy 

Indications

Improved function and position of the fingers

Serious or frequently occurring risks

Pain: from operation: Usually paracetamol +/- Ibuprofen is sufficient

Complex Pain Reaction:  This will occur every 1 in 3000 patients and may lead to so much pain that you cannot use your hand for 2 years

Infection:  This is rare in hand surgery.  Approximately 5 patients a year in Derby will get a major hand infection that alters the outcome of their surgery.  It is more common in diabetes.

Scar: You will have little puncture wounds from the needle.  These will be permanent and may be red, angry, itchy, tender or lumpy for a prolonged time e.g. 6months.  However the majority of people cannot even see them by 1 month.  10% of patients will have a small skin tear which will require dressings for 2-3 weeks and may preclude driving, swimming, work and sports.  Whilst we can often predict if it is likely, some patients will get this despite our best efforts.  It does not affect the final outcome of the treatment.

Failure:  The success rate is approximately 90 to 95%.  Some people will need a second procedure but approximately 5% of patients will have ongoing permanent problems.

Nerve damage:  May occur and lead to permanent numbness (<5%)

Recurrence:  All patients will recur depending on the nature and site at some time.

 

Information letter

I saw you in the clinic today and we decided that we would go ahead with treatment for your Dupuytren’s disease.  

As you know surgical removal of the Dupuytren’s disease is the standard treatment throughout the world.   However, it is associated with a significant recurrence rate and there is always a risk of complications in terms of nerve damage etc.  

I discussed with you the relatively new treatment of needle aponeurotomy which has only been carried out in this country for a short period of time although it has been carried out in Europe for a much longer period of time, especially in Paris.   

The early reports by Surgeons suggested that they felt that this had a significantly higher recurrence rate and a somewhat higher risk of complications.   However, as needle aponeurotomy was invented by Rheumatologists rather than Surgeons there is perhaps a little bit of inter-disciplinary competition here.

The National Institute of Clinical Effectiveness produced guidance on needle fasciotomy for Dupuytren’s disease in 2004.

I have been carrying out a limited form of needle aponeurotomy in the palm for very many years but have recently extended this using the European technique into the hand.   We have probably done in the region of 50 fingers now with this technique with no complications and extremely good results.   This is on the background of having done in excess of a 1000 Dupuytren’s procedures.

The treatment consists of attending my private rooms where under a very small amount of local anaesthetic we will use a 25 gauge needle to release the contractures.   Following this you will have small Elastoplasts placed over the wounds and a splint made for you.   There is a low chance (10%) of a small tear in the palmar skin especially in older patients.  

Following the surgical treatment I advise routine, regular use of Paracetamol and Ibuprofen (unless you are asthmatic or prone to stomach ulcers in which case you should consult your GP for advice about pain relief) for the first 72 hours.   In addition I believe that the use of icepacks is very helpful in reducing swelling and reducing the pain.

We are not removing the whole of the Dupuytren’s and therefore it is common to have the lumps of the Dupuytren’s left in the palm.   The vast majority of these will soften over the next few months but occasionally a small steroid injection into one or two of the lumps is required to promote further softening and removal of the Dupuytren’s tissue.

A proportion of patients 20 – 25% develop a flare at about 6 weeks where the hand can become somewhat swollen and red.   This again is normally treated with the use of non-steroidal anti-inflammatory drugs such as Ibuprofen. 

When you are having your splint fitted the occupational therapist will provide you with advice on using your hand and maintaining the movement in your hand. 

If you come from a long distance away then we frequently, for simple Dupuytren’s disease, return you immediately to the care of your GP but for more advanced Dupuytren’s disease then we will arrange to see you for follow up a few weeks after the surgical treatment.

If you have any further questions about your treatment please do not hesitate to email or contact us by post.

 

 

What to bring

Painkillers: Paracetamol and Ibuprofen

Frozen ice packs and some means to keep them cold

A driver to take you home.