What is Dupuytren’s Contracture?
Dupuytren’s Contracture is a thickening of the deep tissue that passes from the palm into the fingers, and can cause the fingers to be flexed towards the palm as the disease progresses. It frequently affects the ring and little fingers, but may affect any fingers (or thumbs) of either hand. Symptoms usually start as a small nodule or pit in the palm of the hand, which can then develop into cords of tissue that pull the fingers back towards the palm (the Contracture). Not all patients will develop contractures and may be monitored only.
Why would I get Dupuytren’s Contracture?
There is no known cause for the contracture, although it can run in families. It may also be noticed after trauma to the hand (including surgery), in some diabetics, epileptics or in some individuals with liver disease. There is no truth, however, that the condition is related to alcoholic intake.
What can be done about Dupuytren’s Contracture?
A considerable amount of research is taking place to create a drug treatment for the condition but at present none is available. As a result, surgery is the only available treatment once the condition becomes significant. Untreated, Dupuytren’s Contracture can result in affected fingers being pulled into the palm with significant loss in hand function.
Collagenase injection
More recently an enzyme has been developed, Collagenase (xiapex) which can be injected on day 1 and the cord snapped under a local anaesthetic 24-48 hours later. This treatment is suitable for certain disease patterns only.
Common operations to treat this condition are:
Needle fasciotomy
This is a local anaesthetic procedure, where the cord of disease is divided improving the contracture but does not necessarily straighten it. However it is a quick and simple procedure with minimal downtime, however in general terms, it also has a higher recurrence rate than surgery.
Fasciectomy
This involves the removing the affected tissue to correct the bent joints. The entire wound is then stitched up in a ‘zig-zag’ manner, but a segment of the wound may be left open to heal by itself (open-palm technique). The operation is usually performed as a day-case under an anaesthetic that numbs the entire arm or a general anaesthetic.
Dermofasciectomy
In some cases it is necessary to remove the skin overlying the affected tissue because it is involved with the disease, or if the disease has recurred after previous surgery. The skin may also be removed in younger patients (20-40) who can be prone to further recurrence after a simple fasciectomy.
In this procedure, the removed skin is replaced by skin grafted from the elbow or groin crease.
In very rare cases, a finger amputation may be necessary or even preferable, if the condition has returned many times with repeated nerve and vessel damage.
How long will it take to recover?
Recovery times are dependent on the severity of the condition, but a splint may be needed for many months after the operation to maintain the surgical correction of the finger(s). At first, it will be necessary to wear the splint night and day, but often this reduces to night-time only after about a fortnight (when your stitches are removed).
As a result of the need for a splint, many normal activities, such as driving and working, may be difficult or not possible for a while after surgery. You will be left with a scar across the palm and finger(s), and also in the elbow crease if you require a skin graft.
These scars may be tender for 6-8 weeks after the operation. Mr Colville can discuss the exact nature of your treatment, including procedure details, recovery times and any possible side-effects at a consultation. This will reflect your exact circumstances and needs.