Dermofasciectomy and Skin Graft for Dupuytrens contracture therapy

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Two weeks:

The postoperative dressing, sutures and joint pins are removed.

Dressing and immobilizing splint are reapplied.

Four weeks:

Active and Passive Range of Motion exercises are initiated 6 times / day for 15 minute sessions.

Recommendations regarding skin graft moisturizing and protection from shearing forces and direct trauma are reviewed.

A Dupuytren's splint is fitted in full extension only at night. When multiple digits are involved, a full extension Resting Pan splint is indicated.

A Web Spacer is fitted when palmar tissue has been removed from the 1st web space.

A silicone elastomer insert may be fitted beneath the splint once the wound has healed to provide compression to the scar and reduce hypertrophy.

Electrical muscle stimulation may be used as needed to facilitate tendon excursion once the edema has subsided.

Taping and/or dynamic flexion splinting may be initiated to increase Passive Range of Motion as needed.

A stress loading program is initiated and the physician is notified if the patient develops signs of vasomotor instability, excessive sweating, temperature change, worsening pain or progressive stiffness and swelling.

Daytime splinting may be used for outdoor protection at the patient's discretion.

6 weeks:

Daytime splinting is discontinued.

8 weeks:

Strengthening is initiated when pain and swelling are not a minimum and the wounds have healed (foam, putty, hand helper).

Night splinting is continued for six to twelve months postoperatively.

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