Mateusz Gładysz FESSH prep

FESSH prep Dupuytren disease Pooled rates of digital nerve injury and complex regional pain syndrome, neurovascular risk in recurrent disease, systemic risk by type of anaesthesia, consensus definitions of recurrence

Complications of fasciectomy for Dupuytren disease

Last reviewed v1.0

FESSH-074Dupuytren disease●●○ intermediate

Regarding complications of fasciectomy for Dupuytren disease:

  1. 1.Pooled data put the rate of nerve injury after limited fasciectomy at about 3%.

  2. 2.In a 20-year literature review, studies that compared primary with recurrent disease reported similar rates of digital nerve and artery injury in the two groups.

  3. 3.Complex regional pain syndrome is a recognised major complication of fasciectomy, reported in about 3–6% of cases in pooled data.

  4. 4.In a national cohort, Dupuytren operations routinely performed under general or regional anaesthesia carried an increased risk of serious systemic complications, such as myocardial infarction.

  5. 5.Recurrence after fasciectomy is reported against a single, long-established definition, so recurrence rates are directly comparable between studies.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-074
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. Pooled data put the rate of nerve injury after limited fasciectomy at about 3%.

    True

    A 2025 systematic review and meta-analysis of 26 studies (10,831 patients) estimated nerve injury at 3% after limited fasciectomy. Denkler's earlier 20-year literature review reported digital nerve injury in 3.4% and digital artery injury in 2% of fasciectomies.

    • Raval P, Kulkarni K, Johnson N, Divall P, Nevill C, Sutton A, et al.. Frequency and Reporting of Complications after Dupuytren Contracture Interventions: A Systematic Review and Meta-Analysis. Plast Reconstr Surg. 2025;155(1):115-125. PMID 38548710
    • Denkler K. Surgical complications associated with fasciectomy for dupuytren's disease: a 20-year review of the English literature. Eplasty. 2010;10:e15. PMID 20204055

  2. 2. In a 20-year literature review, studies that compared primary with recurrent disease reported similar rates of digital nerve and artery injury in the two groups.

    False

    In the three studies in Denkler's review that compared primary with recurrent disease directly, digital nerve and artery injuries were about ten times more common in recurrent disease (about 20% against about 2%). The authors note that the numbers were too small for statistical significance, so the size of the difference is imprecise, but the reported rates were far from similar.

    • Denkler K. Surgical complications associated with fasciectomy for dupuytren's disease: a 20-year review of the English literature. Eplasty. 2010;10:e15. PMID 20204055

  3. 3. Complex regional pain syndrome is a recognised major complication of fasciectomy, reported in about 3–6% of cases in pooled data.

    True

    Denkler's review listed complex regional pain syndrome in 5.5% of fasciectomies, among major complications totalling 15.7%. The 2025 meta-analysis estimated 3.3% after limited fasciectomy, while noting poor and inconsistent reporting of complications across studies.

    • Denkler K. Surgical complications associated with fasciectomy for dupuytren's disease: a 20-year review of the English literature. Eplasty. 2010;10:e15. PMID 20204055
    • Raval P, Kulkarni K, Johnson N, Divall P, Nevill C, Sutton A, et al.. Frequency and Reporting of Complications after Dupuytren Contracture Interventions: A Systematic Review and Meta-Analysis. Plast Reconstr Surg. 2025;155(1):115-125. PMID 38548710

  4. 4. In a national cohort, Dupuytren operations routinely performed under general or regional anaesthesia carried an increased risk of serious systemic complications, such as myocardial infarction.

    True

    Among 158,119 Dupuytren operations in England, serious systemic complications within 90 days were uncommon overall (0.78%), but operations routinely done under general or regional anaesthesia carried an increased risk. The authors suggest that high-risk patients be treated under local anaesthesia.

    • Alser O, Craig RS, Lane JCE, Prats-Uribe A, Robinson DE, Rees JL, et al.. Serious complications and risk of re-operation after Dupuytren's disease surgery: a population-based cohort study of 121,488 patients in England. Sci Rep. 2020;10(1):16520. PMID 33020582

  5. 5. Recurrence after fasciectomy is reported against a single, long-established definition, so recurrence rates are directly comparable between studies.

    False

    Lack of agreement on what constitutes recurrence has made treatments hard to compare. Two Delphi consensus studies proposed joint-level definitions. Kan and colleagues compared contracture in each treated joint at one year with its six-week postoperative baseline; their abstract uses a threshold of more than 20°, whereas their full-text results and conclusion specify an increase of at least 20°. Felici and colleagues defined recurrence as an increase in passive extension deficit of more than 20° in at least one treated joint, with a palpable cord, compared with the postoperative baseline measured between six weeks and three months.

    • Kan HJ, Verrijp FW, Hovius SER, van Nieuwenhoven CA, Dupuytren Delphi Group, Selles RW. Recurrence of Dupuytren's contracture: A consensus-based definition. PLoS One. 2017;12(5):e0164849. PMID 28505187
    • Felici N, Marcoccio I, Giunta R, Haerle M, Leclercq C, Pajardi G, et al.. Dupuytren contracture recurrence project: reaching consensus on a definition of recurrence. Handchir Mikrochir Plast Chir. 2014;46(6):350-4. PMID 25412239