Dupuytrens Dressing Change
Many patients will have had a forearm local anaesthetic block at the time of surgery and so will be comfortable.
It is important to read the Operation Report because each case may have specific issues.
When the patient arrives in the ward it is vital that the arm is elevated. The arm should be placed in a drip stand sling but the sling is used to stop the arm from flopping sideways and is not aimed at supporting the weight of the arm.
It should be resting on a pillow.
The next day the dressing should be changed. The crêpe bandage is removed and the plaster slab will be reused.
It is important to take note of the orientation of the plaster so that when it is reapplied it is in the position.
The aim of the plaster is that it holds the fingers in extension.
The drain is not sutured in and is usually removed the morning after surgery.
Skin Grafts
Often there will have been skin grafting to the hand. The donor site is usually the inner arm.
It is important to leave the inner dressing intact. This stays in place for two weeks.
These stitches are buried and don’t need to be removed.
The Steri-Strips under the op-site dressing are holding the wound together and should not be touched for two weeks.
This wound is under some tension so do NOT remove steristrips. They can then be allowed to wash off.
If blood has soaked through the dressings onto the plaster remove the obviously soiled bits of the velband and wrap three or four further layers of velband onto the plaster.
It is really important to pay attention to the orientation of the plaster slab so that when it is re-applied it is in the right place usually on the volar aspect of the arm.
If there is a drain it is not sewn in. It should be de- vacuumed and then removed.
When changing the dressings it is vital to leave the skin graft tie over dressings in place.
It is also desirable to avoid getting the tie over dressings too wet with normal saline.
Clean the other areas of the wound which are on review with normal sideline and then reapply Mepitel, padding and Coban bandage.
It is very easy to apply the Coban bandage too tight.
Unwrap the Coban off the role and then De-tension it and then wrap it loosely around the hand.
The biggest problem with dressings is that they can be applied too tight.
It is vital that you can see the tips of the fingers to do proper circulation checks because the patient will not be able to feel their fingers due to the anaesthetic block.
If there has been a skin graft we often hold the hand immobilised for seven days.
If there is no skin graft then we may start moving the finger immediately.
The patient should see the hand therapist within a couple of days from the time of surgery to have a plastic splint fitted.
If a patient complains of disproportionately severe pain is usually due to the dressings being too tight.
There is no problem in loosening these dressings if the patient feels they are too tight.
Discharge from Hospital
The patient will see the Hand Therapist in the 1st few days post-operatively for finger exercises and the application of a light weight plastic splint. This is worn at night and the fingers are exercised during the day.
It is important to emphasize to the patients to keep the hand well elevated particularly if they have had a skin graft.
The patient should be given 2 copies of the Operation Report to take home. 1 is for their records and the other is for the Hand Therapist.
They should be provided with a sling to take home.