Dupuytren's Contracture Surgery
in Rockhampton

What is going on

Dupuytren's disease is a slow thickening of the fascia in the palm and fingers that pulls one or more digits — most often the ring and little fingers — into a flexed position. The earliest sign is usually a firm nodule in the palm that's mistaken for a callus. Over years the nodules form cords, and the cords contract. The disease is more common in men over 50, in patients with northern European ancestry, and runs in families. The progression is unpredictable: some patients have stable disease for decades, others contract a finger over a single year.

Not sure if this is the right diagnosis? The hand pain hub triages the differential by anatomical location.

What the operation involves

Open palmar fasciectomy excises the diseased cords and nodules through zigzag incisions in the palm and fingers, preserving the digital nerves and arteries that often run through the diseased tissue. The operation is usually performed under regional or general anaesthesia as a day or short-stay case. The full clinical and aftercare detail is on the education page, and the Dupuytren's disease education page covers the underlying condition.

For full clinical detail — incision, anaesthetic, post-operative instructions and the printable patient handout — see the dupuytren's surgery education page or the hand surgery overview.

How this case is handled

Hand therapy is on-site at Mater through Extend Rehabilitation, with the option to coordinate ongoing therapy with a clinic closer to the patient's home if travel is an issue. Dr Hirpara reviews each Dupuytren's case individually before recommending the surgical option that fits the contracture pattern.

Fees, Medicare rebates and the surgery-quote process are on the fees page. The case for seeing a fellowship-trained surgeon — and what fellowship training adds — is set out separately. GPs can find the referral pathway, urgency triage and what to include in the letter on the referrer page.

What this operation is billed under

The procedure is covered by the following Medicare Benefits Schedule items. Surgeon, anaesthetist, assistant, hospital and prosthesis fees are quoted separately and in writing before surgery — see the fees page for the practice's quote process and an explanation of why surgical fees follow the Australian Medical Association schedule. Surgery does not proceed without itemised written informed financial consent.

Item 46372 / 46375 / 46378 / 46379 / 46380 Fasciectomy for Dupuytren's contracture

Primary fasciectomy, graded by number of rays operated on (1 / 2 / 3 / 4 / 5)

Item 46381 Interphalangeal joint release

Per joint, when performed alongside fasciectomy for a long-standing PIP contracture

Item 46384 Z-plasty or local skin flap

Per flap, when local skin rearrangement is needed to close the wound without tension

Item 46387 / 46390 / 46393 / 46394 / 46395 Revision fasciectomy

Repeat fasciectomy after a previous Dupuytren's operation, graded by number of rays

Patient questions we hear most

• What's the recurrence rate after Dupuytren's surgery?

  Dupuytren's disease has a higher recurrence rate than most hand conditions because the underlying disorder is biological rather than mechanical — surgery removes the thickened tissue but doesn't change the underlying tendency of the palm to produce it. Published recurrence rates after open fasciectomy vary widely and depend on definition (clinical recurrence vs symptomatic re-contracture), follow-up duration, age at first surgery, family history, and bilateral involvement. Patients with strong family history and early onset of symptoms are at the highest risk. Surgical revision is feasible but more demanding than primary surgery, and is discussed individually.

• Are needle aponeurotomy or collagenase (Xiapex) options I should consider?

  Collagenase clostridium histolyticum (Xiapex) was an injection-based alternative to surgery available in Australia for a number of years; the product was withdrawn from the Australian market by the manufacturer in 2020 and is no longer available. Needle aponeurotomy (also called needle fasciotomy) — a percutaneous division of the cord with a needle, performed under local anaesthesia — remains an option in some practices for early metacarpophalangeal joint contractures with a discrete palpable cord; it does not address the underlying nodules and has higher early recurrence rates than open fasciectomy. The practice's standard approach for established contractures is open palmar fasciectomy.

• Needle fasciotomy versus open surgery for Dupuytren's — what's the difference?

  Both techniques aim to straighten a Dupuytren's contracture, but they address the disease differently. Needle fasciotomy (also called percutaneous needle aponeurotomy) divides the cord with a needle through the skin under local anaesthesia; no incision is made, and use of the hand resumes within days. The diseased fascia and nodules are left in place. Open palmar fasciectomy excises the diseased fascia and cords through zigzag palmar incisions under regional or general anaesthesia; recovery is longer (dressings for one to two weeks, hand therapy and a custom night extension splint over several months) but the diseased tissue is removed rather than divided. In the published comparison, needle fasciotomy has a substantially higher recurrence rate at three to five years than open fasciectomy, and is less effective at the proximal interphalangeal joint and in nodular disease. The Cochrane review of surgical interventions for Dupuytren's contracture sets out the comparative evidence in detail. The practice offers open palmar fasciectomy as the standard approach for established contractures because the comparative evidence favours durability over short-term recovery, and because PIP joint and nodular disease — the cases most likely to need a surgical opinion — are not reliably addressed by the percutaneous technique.

• How much does Dupuytren's surgery cost? What does Medicare cover?

  Dupuytren's surgery is normally performed under regional or general anaesthesia, so a separate anaesthetist gap applies on top of the surgeon and hospital fees. The practice quotes the surgical fee in writing before booking — the Medicare item, the rebate and the out-of-pocket gap each shown separately. The Medicare item is graded by the number of rays operated on (more involved cases attract a larger schedule fee, but also a larger gap). Dr Hirpara's surgical fees follow the Australian Medical Association schedule, which is higher than the Medicare scheduled fee; the fees page explains why. Surgery does not proceed without itemised written informed financial consent.

• Will I need a skin graft?

  In severe or long-standing contractures, the skin can shorten over a contracted cord and simple closure of the surgical incisions may not be possible. Three options are available: a Z-plasty or small local skin flap (the most common technique — skin rearrangements that lengthen the closure without a graft); the open-palm technique (leaving a small area to heal by secondary intention, which heals reliably and limits early stiffness); or a dermofasciectomy in severe or recurrent disease, where both the diseased fascia and the overlying skin are excised and replaced with a small skin graft from the forearm or upper arm. Dermofasciectomy is performed in the same operation by Dr Hirpara — the ortho-plastic hand training at Wythenshawe and Salford covers all three approaches.

• Can multiple fingers be done at the same time?

  Yes — several rays in the same hand are commonly addressed in a single operation; the surgical exposure runs in zigzag fashion across the palm and into the involved fingers, and the recovery is comparable to a single-digit case. Bilateral surgery — both hands at once — is generally avoided for the same reason as bilateral carpal tunnel: dressings on both hands make self-care difficult through the early recovery, and the second hand is usually addressed at a later date.

• What are the main risks of Dupuytren's surgery?

  Risks of open palmar fasciectomy include injury to the digital nerves or arteries (uncommon but recognised — the diseased tissue often surrounds these structures, requiring careful dissection), wound-healing problems (more likely in smokers or patients with poor circulation), infection, and persistent stiffness in operated joints, particularly the proximal interphalangeal joint where the contracture has been long-standing. Recurrence over the longer term is the most clinically important risk and is discussed pre-operatively. Individualised risk is set out at the consultation.

• Do I need hand therapy after Dupuytren's surgery?

  Yes — hand therapy is integrated into Dupuytren's recovery and is more intensive than for routine carpal tunnel or trigger finger. Every patient sees Ruby Doolan at Extend Rehabilitation for the first dressing change and ongoing care, including a custom night extension splint that is worn for several months to maintain extension while the surgical incisions heal. Daytime motion is encouraged early to keep the fingers gliding through the healing tissues. The therapy schedule typically runs over several weeks to months depending on the contracture pattern and the post-operative response.

More general questions about appointments, fees and the practice on the FAQ page.