Dupuytren's contracture is a common hand problem. Its treatment, other than percutaneous fasciectomies is performed as an outpatient surgery under regional or general anesthesia. If local anesthetics are used, they are used without epinephrine, and an arm or forearm tourniquet is essential. Multiple reviews have described the safety of local anesthetics with epinephinre in the digits. This study is a retrospective review of surgeries performed by the same surgeon in the hospital (43 digits) versus using local anesthetics with epinephrine and no tourniquet (60) digits in an office operating room. Results and complications were compared and tabulated. The groups were equivalent in regards to pre-operative measusurements except that the hospital group had slightly worse pre-operative MCP measurements and had slightly more rays operated upon at each surgical session. Post-operative improvement in extension at the MCP joint and PIP joints was similar in both the hospital and epinephrine groups. Complications including digital nerve and artery injuries, infections, hematomas, and reflex dystrophy were statistically equivalent between the groups. There were no cases of digital necrosis or gangrene in the epinephrine group, even though one patient sustained a transection of the digital artery at the PIP joint which was reversed successfully after the applicaiotn of nitroglycerin ointment and the passage of time. Due to the similarities in results, there does not seem to be an advantage to performing Dupuytren’s excisions with full arm tourniquet and outpatient admission in many cases.
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