Can Dermofasciectomy for Dupuytren Disease be Performed Safely and Effectively Under Local Anesthesia with Adrenaline?

Abstract

Purpose

Wide-awake local anesthesia no tourniquet (WALANT) surgery is well suited to dermofasciectomy for Dupuytren contracture because it permits active assessment of the central slip after disease excision; however, it is seldom performed. This study had two main aims: first, to describe our technique for dermofasciectomy under WALANT; second, to compare outcomes with dermofasciectomy performed under WALANT and regional anesthesia (RA).

Methods

This retrospective cohort study included all patients treated with dermofasciectomy by the senior author in a single center between April 2020 and April 2024. Outcome data on disease characteristics, perioperative complications (eg, digital nerve/artery injury, digit loss, graft loss, cardiorespiratory complications related to anesthesia) and reoperation rates were compared between WALANT and RA groups.

Results

Eighty-one digits in 61 patients underwent dermofasciectomy over the 5-year study period. Forty-two digits in 32 patients had dermofasciectomy under WALANT, and 39 digits in 29 patients under RA. The total surgical time was similar in both the RA and WALANT groups, as were the rates of digital nerve or artery injury, graft loss, postoperative infection, and reoperation. In the WALANT group, no operation required conversion to general anesthesia or RA, all patients went home on the same day as surgery, and there were no local anesthesia-related complications such as anesthetic toxicity or digital ischemia from local anesthetic with adrenaline.

Conclusions

It is feasible to perform dermofasciectomy under WALANT.

Type of study/level of evidence

Prognostic IV.