After your surgery · Nicholas Genovese, M.D.
Dupuytren fasciectomy
Surgery to remove the thick cords that pull the fingers into the palm
About your surgery
- The thickened cords of Dupuytren disease were removed so the fingers can straighten. Keeping the gains depends on hand therapy, night splinting and your home exercises. Dupuytren disease can come back over time.
Day of surgery
The first three days
Keep your hand higher than your heart as much as you can. Rest it on pillows when you sit or sleep. This is the most important thing you can do for swelling and pain.
Put ice over the dressing or splint for 15–20 minutes at a time, several times a day. Never put ice directly on the skin, and do not let the dressing get wet.
Move the parts that are not in the dressing or splint: open and close your fingers, and gently move your elbow and shoulder every hour while awake.
Some swelling, bruising and soreness are normal. Bruising can travel down into the fingers.
Use the hand for light tasks only. Do not lift anything heavier than a coffee cup with the operated hand until your surgeon tells you that you can.
Dressing and bathing
Leave the dressing in place until your first follow-up visit unless you were told otherwise.
You may shower after 24 hours. Tape a waterproof bag over the dressing so it stays dry.
If the outer wrap feels too tight, or your fingers stay swollen after elevating and moving them, loosen and rewrap only the outer elastic wrap. Do not remove the bandage over the incision.
Do not soak the arm in a bath, hot tub, pool or the ocean until the stitches are out and the incision is fully closed.
Splint or sling
- Keep the dressing on until your first visit.
- Your hand therapist will make a splint to hold the fingers straight, usually worn at night for several months.
If you had a nerve block
A nerve block keeps the arm numb for about 8–24 hours. Protect the arm while it is numb: keep it in the sling or on pillows, and keep it away from heat, cold and sharp edges.
Start your pain medicine before the block wears off, usually the evening of surgery or before bed, so the pain does not catch up with you.
Pain control
Follow the plan your surgeon gave you and the directions on your prescription labels. Unless you were told otherwise, the plan below works well for most patients.
Acetaminophen (Tylenol 8 HR Arthritis Pain, 650 mg): one tablet every 8 hours for the first 3 days, even if your pain is mild, then as needed. Do not take more than 3,000 mg of acetaminophen a day from all sources. Many prescription pain pills also contain acetaminophen, so count them too.
Naproxen 500 mg (or the anti-inflammatory your surgeon prescribed): twice a day with food for the first 3 days, then as needed. Only take it if anti-inflammatory medicine is safe for you. Do not take it if you have kidney disease, a stomach ulcer or stomach bleeding, take a blood thinner, are pregnant, or were told to avoid these medicines.
Stronger prescription medicine for breakthrough pain: take it only as written on the label, and only if you need it, usually at night. It can cause drowsiness and constipation. Drink 6–8 glasses of water a day and use a stool softener such as Colace while you take it. Do not drive, drink alcohol or make important decisions while taking it.
The worst pain is usually in the first 48 hours. Most patients need nothing stronger than acetaminophen and naproxen after 3–5 days.
Prescription refills and changes are handled during business hours only, not at night or on weekends.
Activity and lifting limit
- No sports, heavy lifting or vigorous activity until your first visit.
Driving
Do not drive while you are taking prescription pain medicine, while your arm is numb from a block, or while a splint or dressing keeps you from controlling the wheel safely.
Exercises to start now
Finger motion (open and close)
Start: day 1, gently
Open your hand fully, then slowly close it into a comfortable full fist. 10 times every 1–2 hours while awake. Move within the splint or dressing; do not force it.
Swelling control
Start: day 1
Keep the hand above heart level when resting and pump the fingers open and closed often. If the fingers stay puffy after the first week and your surgeon or therapist approves, wrap each finger lightly with Coban from the tip toward the hand. Remove any wrap that makes the fingertips cold, blue or numb.
Your first post-op visit
Your first post-op visit is usually about 2 weeks after surgery. The date and office are on your appointment card. If you cannot make it, call (858) 560-0242.
When to call the office
Call the office at (858) 560-0242 immediately if you have any of the following:
- Fever above 101.0 °F or chills
- Redness, warmth or red streaks spreading from the incision
- Drainage from the incision, especially cloudy or bad-smelling drainage
- Pain that is getting worse or is not controlled by your medicines
- New or worsening numbness, tingling or weakness
- Fingers that turn blue, white or cold, or stay very swollen after elevating your hand for an hour
- A splint or wrap that still feels too tight after you loosen the outer elastic wrap and elevate your hand
- Bleeding that soaks through the dressing
If you cannot reach us and the problem is urgent, go to the nearest emergency room or call 911.
Call 911 or go to the nearest emergency room for chest pain, trouble breathing, or new calf pain or swelling.
After your first post-op visit: home exercises
General principles
Start these at or after your first post-op visit, when your surgeon or therapist tells you to.
Exercises by phase
Tendon gliding
Start: when your therapist starts them
Move slowly through five positions, holding each for 3 seconds: straight hand, hook fist (knuckles straight, middle and tip joints bent), tabletop (knuckles bent, fingers straight), straight fist, full fist. 10 rounds, 3–5 times a day.
Scar massage
Scar massage
Start: after the stitches are out
Start only after the stitches are out and the incision is fully closed, with no scabs or drainage (usually about 2–3 weeks). Use a fragrance-free moisturizer such as Aquaphor. Press firmly enough to move the skin and massage in small circles, then side to side and up and down. 2–3 minutes, 2–4 times a day for 6–8 weeks. Protect the scar from the sun for several months.
Hand therapy
- Hand therapy usually starts at about 1 week to control swelling, care for the wound and improve finger motion.
- Therapy continues after the stitches come out at 1–2 weeks.
What not to do yet
- No sports, heavy lifting or vigorous activity until your first visit.
When to call the office
Call the office at (858) 560-0242 immediately if you have any of the following:
- Fever above 101.0 °F or chills
- Redness, warmth or red streaks spreading from the incision
- Drainage from the incision, especially cloudy or bad-smelling drainage
- Pain that is getting worse or is not controlled by your medicines
- New or worsening numbness, tingling or weakness
- Fingers that turn blue, white or cold, or stay very swollen after elevating your hand for an hour
- A splint or wrap that still feels too tight after you loosen the outer elastic wrap and elevate your hand
- Bleeding that soaks through the dressing
If you cannot reach us and the problem is urgent, go to the nearest emergency room or call 911.
Call 911 or go to the nearest emergency room for chest pain, trouble breathing, or new calf pain or swelling.
About these instructions
These instructions are general guidelines for patients of Nicholas Genovese, M.D. Your surgeon may change your plan based on your surgery and how you are healing. If anything here differs from what your surgeon or therapist told you, follow their instructions, and call the office before changing any activity, splint use or therapy.