Fellowship-Trained Expert in Hand and Upper Extremity Surgery
When Dupuytren’s disease progresses to the point that the fingers can no longer straighten, open Dupuytren’s hand contracture surgery becomes the most effective and lasting way to restore motion. Dr. Thomas Neustein, a board-certified and fellowship-trained orthopedic hand and upper extremity surgeon, provides expert open surgical treatment for Dupuytren’s contracture across North Georgia.
His extensive orthopaedic surgery background, advanced microsurgical training, and reputation for great bedside manner make him one of the most trusted hand surgeons in the region. Patients consistently describe their experience as a pleasant experience with excellent outcomes, less pain, and a caring surgeon who takes great detail in explaining every step of the treatment plan.
Understanding Dupuytren’s Disease
Dupuytren’s disease, also called Dupuytren’s contracture, is a progressive condition that affects the fibrous layer beneath the skin of the palm. Over time, thick cords of scar-like tissue form, causing one or more fingers—most often the ring finger or small finger—to bend toward your palm.
In early stages, patients may notice small lumps or nodules beneath the skin. As the disease advances, the cords tighten, pulling the affected fingers into a bent position and making it impossible to place the hand flat on a flat surface, a test known as the tabletop test.
Causes and Risk Factors
The exact cause of Dupuytren’s contracture remains unclear, but several risk factors have been identified. The condition tends to run in families and is more common in people of Northern European descent. Risk factors include:
- Family history of Dupuytren’s disease
- Male gender, typically over age 50
- Tobacco and alcohol use
- Diabetes or seizure disorders
- History of hand trauma or repetitive work with vibration tools
Dupuytren’s disease is not caused by overuse or arthritis, and it is not considered an inflammatory condition. Instead, it results from a thickening of the connective tissue in the palm known as the palmar fascia.
Symptoms and Early Signs
Patients with Dupuytren’s disease often first notice firm nodules in the palm, usually near the base of the ring finger or small finger. These may feel like small lumps under the skin and are not typically painful. Over time, the nodules form thickened cords that shorten and pull the affected fingers toward the palm.
Common symptoms include:
- Tightness or thickened tissue in the palm
- Finger stiffness or inability to fully straighten one or more fingers
- Difficulty placing the hand flat on a table
- Progressive loss of hand function
- Cords visible under the skin
In severe cases, the affected fingers may become fixed in a bent position, interfering with daily activities like washing, shaking hands, or putting on gloves.
Diagnosing Dupuytren’s Contracture
Diagnosis of Dupuytren’s contracture is based on a detailed medical history and physical examination. Dr. Neustein assesses hand function, range of motion, and the presence of thick cords or nodules.
The tabletop test is commonly used: if the patient cannot lay the hand completely flat on a flat surface, a contracture is present. X-rays are rarely needed, since the problem arises from diseased tissue under the skin rather than the bone or joint.
When to Consider Surgical Treatment
Not all patients with Dupuytren’s contracture require surgery. In early or mild cases, nonsurgical options such as Xiaflex injection or needle aponeurotomy may provide temporary improvement. However, when the contracture becomes advanced, open Dupuytren’s hand contracture surgery is the most effective and durable solution.
Surgery is typically recommended when:
- The finger cannot be straightened enough to perform daily activities
- Contracture exceeds 30 degrees at the finger joint
- The thickened tissue interferes with hand function
- Prior injections or needle procedures have failed
In severe cases, open surgery allows the removal of all diseased tissue and full restoration of motion to the affected fingers.
Open Dupuytren’s Contracture Surgery Explained
Open Dupuytren’s hand contracture surgery, also known as subtotal palmar fasciectomy, is performed to remove the diseased tissue beneath the skin that causes the fingers to curl. The goal is to restore finger extension and normal alignment of the hand.
During the procedure, Dr. Neustein makes precise incisions in the palm and affected fingers, identifying and removing the thick cords while preserving nerves, blood vessels, and tendons. Depending on the extent of the disease, skin grafting may be used to close areas where the thickened tissue was removed.
This surgical treatment is performed under regional or general anesthesia at an accredited surgery center, ensuring patient comfort and safety throughout the procedure.
The Surgical Procedure Step by Step
- The hand is prepped and draped under sterile conditions after regional or general anesthesia is administered.
- The surgeon makes a zig-zag incision across the palm and along the affected finger or fingers.
- The thickened cord and fibrous tissue are carefully dissected from the underlying structures.
- Nerves, arteries, and tendons are identified and protected using magnification and microsurgical technique.
- The diseased tissue is excised completely to prevent recurrence.
- In severe cases, a small skin graft may be applied to cover open wound areas and facilitate healing.
- The incision is closed, and a light dressing and splint are applied to maintain finger extension.
The surgery typically takes one to two hours, depending on the number of affected fingers and the extent of involvement.
Benefits of Open Surgery Compared to Other Treatments
While needle aponeurotomy and collagenase injections can provide temporary improvement, open surgical treatment remains the most definitive option for advanced or recurrent Dupuytren’s contracture.
Benefits include:
- Complete removal of diseased tissue
- Improved long-term correction and lower recurrence rate
- Ability to treat multiple fingers and extensive cords
- Better visualization of nerves and blood vessels
- Restoration of hand function and range of motion
Patients often report less pain and better long-term satisfaction after open surgery compared to repeat needle procedures.
Recovery and Rehabilitation
After surgery, the hand is bandaged and elevated to minimize swelling. Stitches are typically removed after 10 to 14 days. Physical therapy and occupational therapy begin soon after to restore motion, flexibility, and strength.
Postoperative care includes:
- Wound care and dressing changes as directed
- Gentle stretching and finger movement exercises
- Splinting to keep the fingers straight during healing
- Gradual return to light daily use after two to three weeks
- Ongoing therapy for several months to maintain mobility
Full recovery may take three to six months, depending on the severity of the contracture and the patient’s overall health.
Potential Complications and Risks
As with any surgery, potential complications exist, though they are rare. These may include infection, stiffness, delayed wound healing, or recurrence of the disease. In some severe cases, nerve or blood vessel injury may occur, though this is minimized by using meticulous microsurgical technique.
Dr. Neustein’s extensive experience in upper extremity and microvascular surgery ensures that patients receive the safest and most effective surgical care possible.
Results and Long-Term Outcomes
Patients who undergo open Dupuytren’s hand contracture surgery typically experience significant improvement in finger straightening, hand function, and appearance. Once the diseased tissue is removed and motion restored, most patients enjoy lasting results and pain-free function.
Recurrence is less common after open surgery compared to less invasive procedures. With consistent physical therapy and adherence to the treatment plan, results can be maintained for many years.
Why Choose Dr. Thomas Neustein
Dr. Neustein combines advanced training, surgical precision, and compassion to deliver top-notch orthopedic care. He completed his orthopaedic residency followed by specialized fellowship training in hand, upper extremity, and microvascular surgery. Board certified by the American Board of Orthopaedic Surgery, he is known for his skilled surgical technique, outstanding bedside manner, and commitment to excellent outcomes.
Patients describe him as a great doctor with an amazing team and office staff. His attention to every detail, minimal wait time, and genuine concern for each patient’s needs have made Specialty Orthopaedics a trusted destination for hand surgery in North Georgia.
Who Is a Candidate for Surgery
You may be a candidate for open Dupuytren’s contracture surgery if you:
- Have moderate to severe finger contractures
- Cannot lay your hand flat on a table
- Have failed or declined nonsurgical treatment options
- Experience functional limitations with daily activities
- Are in overall good health for outpatient surgery
A thorough evaluation and discussion with Dr. Neustein will help determine the best treatment plan tailored to your goals and health history.
Life After Dupuytren’s Surgery
After healing, most patients regain near-normal range of motion and strength. Tasks like shaking hands, typing, or grasping objects become easy again. Regular stretching and occasional hand therapy help maintain motion.
Although Dupuytren’s disease can recur over time, early recognition and follow-up allow for prompt management before severe contractures return. Patients who commit to therapy and home exercises typically enjoy long-lasting improvement and better quality of life.
Caring for Your Hand After Surgery
Proper wound care and adherence to the rehabilitation program are key to success. Keep the incision clean and dry, follow dressing instructions, and attend all follow-up appointments. Any signs of infection or delayed healing should be reported immediately.
Physical therapy helps prevent stiffness, while splinting at night keeps the fingers extended. These steps facilitate healing and protect the results of your surgery.
The Role of the Surgical Team
Successful outcomes depend on the collaboration between the surgeon, therapists, and patient. Dr. Neustein works closely with a team of certified hand therapists and experienced staff members who provide personalized support every step of the way. From pre-op education to wound care and final recovery, patients consistently describe a wonderful experience with the entire staff.
Choosing the Right Surgeon for Dupuytren’s Contracture
Dupuytren’s surgery requires a very skilled surgeon with specialized training in orthopaedic surgery and microvascular technique. Dr. Neustein’s expertise in handling diseased tissue, protecting nerves and blood vessels, and achieving natural results makes him the preferred choice for patients throughout Georgia.
As a fellowship-trained hand doctor and caring surgeon, he is dedicated to providing exceptional outcomes for every patient—combining technical skill, compassion, and modern surgical techniques.
Schedule Your Consultation
If you are struggling with Dupuytren’s contracture and cannot fully straighten your fingers, schedule an appointment with Dr. Thomas Neustein to discuss your options. Whether you require Xiaflex injection, needle aponeurotomy, or open Dupuytren’s hand contracture surgery, you will receive a comprehensive evaluation and personalized care plan.
Trust Dr. Neustein and his amazing team to help restore your hand function, relieve pain, and get you back to the activities you enjoy.
