Dupuytren's contracture surgery (Surgery for Dupuytren's disease (fasciectomy / fasciotomy))
Treatment to straighten one or more fingers that have been pulled towards the palm by Dupuytren's disease, using surgery or a less invasive needle or injection technique.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- It straightens fingers bent by Dupuytren's disease and improves hand function; it does not cure the disease.
- Dupuytren's tends to come back after any treatment, and recurrence is more likely after the less invasive needle and injection methods than after open surgery.
- Options range from a quick needle release, to an enzyme injection, to open surgery, each with different recovery and recurrence trade-offs.
- Treatment is usually for fingers bent enough to affect daily life, and hand therapy afterwards is important for a good result.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Straightens the finger and improves your ability to use the hand
You have only early nodules or a mild bend that does not yet affect function, where monitoring is usually better than treatment.
After a needle release, gentle use returns quickly; small skin splits heal over a week or two. After open surgery, keep the hand elevated and the dressing...
A clear hand therapy plan with exercises and, where needed, night splinting to hold the finger straight.
After a needle release, gentle use returns quickly; small skin splits heal over a week or two. After open surgery...
After open surgery, stitches are removed and hand therapy usually begins. A night splint may be fitted to hold the...
Swelling and tenderness settle, movement and grip improve with exercises, and you gradually return to heavier hand...
The scar softens and most people regain comfortable hand function. Splinting may continue at night for a while...
What is Dupuytren's contracture surgery?
Dupuytren's disease makes the tissue just under the skin of the palm (the fascia) thicken into nodules and cords. Over time these cords can pull one or more fingers, usually the ring and little fingers, towards the palm so they cannot fully straighten. This is called a contracture.
Treatment aims to straighten the finger and improve hand function. It does not cure the underlying disease, and there is no treatment that prevents it coming back. The options range from a quick needle release in clinic, to an enzyme injection, to open surgery that removes the diseased cord.
Treatment is usually offered when the bending interferes with everyday tasks, for example when you cannot lay your hand flat on a table, rather than at the first sign of a lump. Early nodules without contracture are often just monitored.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Comparing Dupuytren's treatments
| Needle release | Open surgery | |
|---|---|---|
| What it involves | Cord divided with a needle | Cord removed through a cut |
| Recovery | A few days | Several weeks |
| Coming back | More likely, often within a few years | Less likely, but still happens |
| Best for | Simpler cords, earlier disease | More severe or finger-joint contractures |
Collagenase injection is a third option that sits between these. The right choice depends on which fingers and joints are affected, how severe the contracture is, and your priorities.
Preparing for your surgery
- Discuss which finger and which joints are affected, as this strongly influences which treatment works best.
- Ask about the realistic chance of recurrence with each option, as Dupuytren's commonly returns after any treatment.
- Tell your surgeon about diabetes, epilepsy, alcohol use and any family history, as these are linked to the disease.
- List your medicines, including blood thinners, so the team can advise on any changes.
- Arrange time off and help at home, especially for open surgery, which has a longer recovery and needs hand therapy.
- Plan how you will get home, particularly if you are having sedation or a general anaesthetic.
- Be ready to commit to hand exercises and possibly night splinting afterwards, as these affect the result.
What happens
What happens depends on the technique. A needle fasciotomy is done in clinic under local anaesthetic: the surgeon uses a needle to divide the cord at several points, then straightens the finger. It takes minutes and you go home soon after.
A collagenase injection is given into the cord, and you return a day or two later for the surgeon to straighten the finger, which snaps the weakened cord.
Open surgery (fasciectomy) is done under regional or general anaesthetic. The surgeon makes a cut in the palm and finger, carefully separates the cord from the nearby nerves and blood vessels, and removes the diseased tissue. The skin is closed, sometimes with a graft, and a splint may be applied.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- You have only early nodules or a mild bend that does not yet affect function, where monitoring is usually better than treatment.
- You cannot accept that the disease is likely to return after any treatment.
- Your hand problem is caused by something other than Dupuytren's, such as a tendon or joint condition.
- You are unable to commit to the hand therapy and splinting that a good result after open surgery depends on.
Delay surgery if…
- There is active infection or broken skin over the planned treatment area.
- You are on blood thinners that need reviewing before a procedure.
- Your diabetes or another medical condition is poorly controlled and could be optimised first.
- You cannot arrange the time off and hand therapy that open surgery needs.
Alternatives to discuss
- Monitoring, since early disease without a functional contracture often does not need treatment.
- Needle fasciotomy, a quick clinic procedure with fast recovery but higher recurrence.
- Collagenase injection, where available, as a non-surgical way to weaken and break the cord.
- Open surgery (fasciectomy) or dermofasciectomy for more severe, recurrent or aggressive disease.
- Hand therapy and stretching, which support but do not replace treatment of an established contracture.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Straightens the finger and improves your ability to use the hand
- Can restore the ability to lay the hand flat and grip properly
- Needle and injection options offer a very quick recovery for suitable cords
- Open surgery generally gives more durable correction for more severe contractures
- Can be repeated or switched to another technique if the disease returns
Risks & complications
- Soreness, swelling and bruising of the hand for days to weeks
- Temporary stiffness and reduced grip while the hand recovers
- Small skin tears or wounds that take time to heal, especially with needle release
- A tender scar after open surgery
- The contracture coming back, sometimes within a few years
- Numbness from stretching or bruising of a finger nerve
- Wound infection or delayed healing
- Incomplete straightening, particularly at the middle finger joint
- Permanent injury to a finger nerve, causing lasting numbness
- Injury to a finger artery, very rarely threatening the finger
- Complex regional pain syndrome, a troublesome persistent pain and stiffness reaction
- Loss of part of a finger in severe or repeatedly operated cases
The two issues that matter most are honesty about recurrence, because Dupuytren's tends to come back after any treatment, and the closeness of the finger nerves, which can be stretched or injured. Recurrence is generally more likely after needle and injection treatments than after open surgery, but those are quicker to recover from. An experienced hand surgeon should explain this trade-off and tailor the choice to your fingers.
Published figures to discuss
Dupuytren's is a recurring disease, so the most important figures are recurrence rates, and these vary widely between studies because researchers define and measure recurrence differently and follow patients for different lengths of time. The ranges below come from reviews and series and should be read as broad guides, not precise predictions for any one person.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Recurrence after needle fasciotomy | High; commonly reported around 50% or more within roughly 3–5 years | Quick recovery is traded against earlier and more frequent return of the contracture. | Systematic review of fasciotomy, aponeurotomy and collagenase outcomes — PubMedpubmed.ncbi.nlm.nih.govPublished figure |
| Recurrence after collagenase injection | Wide range reported across studies, broadly comparable to or higher than open surgery over a few years | Tends to suit knuckle (MCP) joints better than the middle (PIP) finger joint. | Guide sourcesClinical context |
| Recurrence after open surgery (fasciectomy) | Generally lower than needle or injection over several years, but still reported across a wide range | Dermofasciectomy with a skin graft has the lowest reported recurrence. | Guide sourcesClinical context |
| Nerve injury during open surgery | Uncommon; reported in low single figures in many series, higher in repeat surgery | The finger nerves run close to the diseased cords, so surgeon experience matters. | Systematic review of fasciotomy, aponeurotomy and collagenase outcomes — PubMedpubmed.ncbi.nlm.nih.govSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Recovery depends entirely on the technique. A needle release lets you use the hand within days. Open surgery needs several weeks, with dressings, hand therapy and often splinting, before full use returns.
- A sore, swollen and bruised hand for the first weeks after open surgery
- Stiffness and reduced grip that improve with hand exercises
- Small skin splits or a tender scar that heal over weeks
- Needing to wear a night splint for a period to hold the finger straight
Aftercare
- Keep the dressing or splint clean and dry until you are told the wound can get wet.
- Elevate the hand in the first days to reduce swelling and throbbing.
- Do the hand exercises you are given regularly, as these strongly affect the result.
- Wear any night splint as advised to help hold the finger straight.
- Take simple painkillers as needed for soreness.
- Avoid heavy gripping and lifting until your surgeon or therapist says it is safe.
- Massage the healed scar if advised, to keep it supple, and keep follow-up appointments.
- Simple painkillers at home
- Time off work arranged, especially for open surgery
- Help at home for the first days if needed
- A way to keep the dressing dry when washing
- Hand therapy appointments noted
- Lift home arranged if having sedation or general anaesthetic
- Clinic contact number saved for any problems
Scars and how they heal
A needle fasciotomy leaves only small puncture marks, though tiny skin splits can occur and heal over a week or two. Open surgery leaves scars across the palm and finger, sometimes zig-zag in shape to avoid tightening, and these are firm and tender at first before softening over months. A dermofasciectomy includes a skin graft, which leaves an additional patch of differently textured skin.
⚠ Get urgent help if…
- Spreading redness, heat or swelling around a wound
- Pus, discharge or a wound that opens up
- Increasing rather than improving pain after the first few days
- A finger that becomes pale, cold, blue or numb
- New or worsening numbness or tingling in the finger
- A hand that becomes very stiff, swollen, shiny or intensely painful out of proportion to the surgery
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A good result is a straighter finger and a hand you can use more normally, for example laying it flat or gripping comfortably. The finger usually straightens at the time of treatment, while grip, movement and the scar settle over weeks.
No treatment cures Dupuytren's disease or stops it returning, and straightening may be incomplete, especially at the middle finger joint where contractures are harder to fully correct. A good surgeon is clear about what is realistically achievable for your fingers and about the chance of recurrence.
Dupuytren's disease is lifelong and tends to recur after any treatment, so durability is measured in years rather than permanence. Recurrence is generally more frequent and sooner after needle fasciotomy and collagenase injection than after open surgery, while dermofasciectomy with a skin graft has the lowest recurrence but the largest operation. Younger age at onset, strong family history and disease elsewhere (such as the knuckle pads or feet) point to more aggressive disease that is more likely to come back.
Combining with other procedures
If more than one finger is affected, your surgeon may treat several cords in one session, or stage treatment over time. Some people have a needle release first for quick relief and later choose open surgery if the disease returns. The plan is individual, and it is reasonable to prioritise the finger that troubles you most.
Follow-up & long-term care
After open surgery you will usually be seen at one to two weeks for stitch removal and to start or continue hand therapy, with further reviews as movement improves. After needle or injection treatment, follow-up checks the result and any skin healing. Report signs of infection, a cold or numb finger, or severe pain straight away. Long term, new or returning cords should be reviewed rather than ignored.
- Keep doing your hand exercises to maintain finger straightening and movement.
- Wear a night splint for as long as advised after open surgery.
- Report new nodules or returning bending early, as repeat treatment is often possible.
- Manage diabetes and alcohol intake, which are associated with the disease.
- Massage the healed scar if advised, to keep it supple.
Revision and secondary surgery reality
- Because the disease recurs, repeat treatment over a lifetime is common and should be expected, not seen as failure.
- Repeat open surgery is more difficult, with higher risks to nerves and skin, and a longer recovery.
- People sometimes start with a needle release and move to open surgery later if the contracture returns.
- Aggressive disease may need dermofasciectomy with a skin graft to reduce the chance of further recurrence.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- A clear hand therapy plan with exercises and, where needed, night splinting to hold the finger straight.
- Written wound-care advice and signs of infection or nerve or circulation problems, with a named contact route.
- Follow-up to check straightening, movement and scar healing.
- Honest discussion about monitoring for recurrence and the option of further treatment if cords return.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The technique chosen, from a clinic needle release to open surgery with a skin graft
- The number of fingers and joints treated
- The type of anaesthetic, as a general anaesthetic adds an anaesthetist and theatre time
- Facility or day-case theatre fee
- The cost of collagenase if an enzyme injection is used
- Hand therapy sessions and any splint
- Follow-up appointments, and the likelihood of further treatment if the disease returns
- The surgeon's fee and the planned technique
- The anaesthetist and theatre or facility fee where relevant
- Any drug cost, such as collagenase
- Hand therapy sessions and splints
- Follow-up appointments and stitch removal
- The cancellation policy
- What happens, and what it costs, if the contracture returns or a complication needs treating
On the NHS? Treatment is available on the NHS when fingers are bent enough to affect function, though local criteria and the techniques offered vary; private care is sometimes chosen for speed, choice or a particular technique.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being told clearly that the disease is likely to return after any treatment.
- Choosing the quickest option without understanding its higher recurrence rate.
- No discussion of the realistic limit of correction, especially at the middle finger joint.
- Underplaying the risk to the finger nerves, particularly in repeat surgery.
- No clear plan for the hand therapy and splinting that a good result depends on.
Marketing red flags
- Presenting any treatment as a permanent cure for Dupuytren's.
- Promoting needle release or injection as obviously superior without explaining higher recurrence.
- Guaranteeing a perfectly straight finger.
- No discussion of recurrence, nerve risk, or the need for hand therapy.
- Pushing treatment for early nodules that are not yet affecting function.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- Which of my fingers and joints are affected, and which treatment suits them best?
- What is the realistic chance of recurrence with each option, and how soon?
- How complete a straightening can I expect, especially at the middle finger joint?
- What is the risk to the finger nerves with the technique you suggest?
- Is collagenase injection or needle release suitable for me, and is it available here?
- What hand therapy and splinting will I need, and when can I return to work and driving?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Will Dupuytren's come back after treatment?
Which is better, needle release, injection or surgery?
Is collagenase injection available on the NHS?
When should I have treatment?
Will my finger be completely straight afterwards?
Can I get this on the NHS?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Dupuytren's contracture BSSH — Dupuytren's disease (patient information) NICE — Needle fasciotomy for Dupuytren's contracture (IPG43) Systematic review of fasciotomy, aponeurotomy and collagenase outcomes — PubMed Additional treatment after collagenase and needle fasciotomy — PMC Safety and effectiveness of percutaneous needle fasciotomy — PMC
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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