Dupuytren’s contracture



Dupuytren’s contracture

Dupuytren’s disease is a thickening of the tissue underneath the palm skin. This deep tissue thickens and forms lumps (nodules) and cords, the tissue shortens and causes contractures, pulling the fingers into the palm.

It is often genetic but there are other causes. The progress of the disease is unpredictable, in many people there is slow progression. If it appears at a young age (under 40yr) then it is often more aggressive and may require multiple operations

Treatment

Collagenase- injection of an enzyme into the cords dissolves some of the tissue, but does not remove the nodules, and allows the finger to be straightened. Only some types of duypuytren’s are suitable for this technique.

Fasciotomy- the cords are cut through a small cut in the palm with a needle or blade. Only some types of duypuytren’s are suitable for this technique.

Fasciectomy- the deep tissue underneath the skin is removed, the tendons are below this layer and can work normally. A zig-zag incision is performed, which is closed occasionally a small area of the wound is left open to heal by itself.

Dermofasciectomy- sometimes the disease is so severe that the skin is heavily involved and needs to be removed, or the patient is very young. A skin graft is taken from the upper arm and placed on the finger. This takes longer to recover from but has a lower recurrence rate.

The finger that has been operated is put in a plaster but the other fingers are left free. This is removed at 2 weeks and then a splint is worn at night to maintain the correction of the finger position. Hand exercises and physiotherapy are then need to get the hand mobilising fully.

Dupuytren’s contracture can recur and is never cured

All procedures have associated small risks, they include

Infection- any operation can be complicated by infection and this would be treated with antibiotics. The wound needs to be kept covered while the skin is healing.

Tender scars- the scars are tender to begin with but improve with mobilisation and massaging them with cream.

Nerve damage- the nerves in the fingers may be damaged at the time of surgery and may cause numbness in the finger, this is more common if previous operations have been performed on the finger.

Bleeding-sometimes this can cause a problem with the wound, and you should tell your surgeon if you are on aspirin or anticoagulants.

Severe pain, stiffness (chronic regional pain syndrome)- a small number of people get a swollen, stiff, painful hand after any hand operation. This cannot be predicted, but taking regular pain relief, elevating and mobilising the hand helps initially and physiotherapy treatment is required.

Deformity correction- sometimes it is not possible to fully straighten the fingers, this may need splinting after the operation.

Skin loss- sometimes a skin graft does not heal- this is unusual if the post-operative advise is followed and you do not smoke.

Finger loss- this is very rare but can occur if there have been many previous operations or you have severe circulation problems.

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