What is Dupuytren’s disease ?
Dupuytren’s disease or contracture is related to thickening of a fibrous structure under the skin of the palm of the hand and fingers .
This thickening is accompanied by retraction, which limits the extension of the fingers.
Usually, the retraction of the fingers is not painful.
Dupuytren’s disease is more common in northern Europe and is more common in men than in women.
Very often another family member also has this disease (father, grandfather, uncle[It often runs in families so another member will have similar presentations e .g. father….]).
Alcohol and some drugs may promote development of Dupuytren’s disease.
In addition to the hands, it can also affect the soles of the feet or -more rarely -other parts of the body.
When should you consider treatment?
Treatment should only be considered if the retraction prevents full extension of the fingers. There is a very simple test:
THE TABLE TEST
Try to flatten your hand on the table. If you can, the test is negative and no treatment is recommended.
If instead one or more fingers cannot be extended enough to lay your hand flat on the table, the test is positive and surgical treatment is probably required.
If your test is negative, monitor the evolution by repeating the table test from time to time. If the test is positive, it is time to see a hand surgeon. A positive test is important to detect because from there, the disease will probably progress.
The more the finger is retracted before the operation, the more difficult it is to restore full extension.
What are the surgical options?
In some cases, it is possible to restore full extension of the finger simply by cutting the Dupuytren’s band with a needle. This technique is called needle fasciotomy .
Fasciotomy provides a very quick recovery; driving and everyday abilities are possible after 1 or 2 days. The disease is not eliminated and the risk of recurrence is high. In case of recurrence, fasciotomy may be redone easily.
However, fasciotomy is not always possible, and despite its apparent simplicity, this procedure can be dangerous if not performed by a specialist[There is risk of nerve injury and loss of sensation to the fingertip.].
In the majority of the cases, treatment involves removing the retracted tissue causing the disease. This is a delicate surgery because vessels and nerves are entangled with the Dupuytren’s bands.
In case of preoperative severe finger retraction, it is not always possible to restore full finger extension.
Sometimes because of skin defect, the palm of the hand is left open .
Healing is then obtained with regular dressings for 2-3 weeks. This is called a healing by granulation. Granulation seems to be a primitive treatment, but in fact it results in an invisible palmar scar and is preferred to a skin graft in selected cases.
A skin graft may be used to cover skin defects .
Healing is faster than granulation and skin grafts may prevent recurrence of the retraction. The drawbacks of skin grafts are the aesthetic appearance both at the recipient and donor sites.In almost all cases, the procedure is performed under local anaesthesia.
You will leave the clinic the same day or the day after surgery.
What to do after the procedure?
It is advisable to keep the hand raised as much as possible, and to move the fingers freely to prevent recurrence of the flexion contracture.
You will see your surgeon usually 8 days after the operation to check the healing.
Sometimes it will be necessary to wear a dynamic extension splint to prevent scarring in flexion. This extension splint must be custom-made and worn 3 to 4 times a day. It may be necessary for 2 to 3 months to regain full extension of the fingers. When the splint is not worn, the fingers must be mobilized. Rehabilitation with a physiotherapist may sometimes be useful.
The disease may recur after surgery, especially when the initial development was rapid and in patients under 40 years old. Reoperation may be necessary.
When done at the right time, surgical treatment of Dupuytren’s contracture is efficient and can restore full extension of the fingers.
An informed consent form will be given before surgery. We hope to inform you as objectively as possible the principles of intervention, but also the risk of complications….[See corresponding paragraph in thumb arthritis]