Dupuytren's Contracture
See also: The New Victoria Orthopaedic Clinic
What is Dupuytren's Contracture?
Dupuytren's Contracture describes a thickening of the deep tissue that passes from the palm into the fingers, that causes the fingers to be flexed towards the palm over time. It frequently affects the little and ring 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 bands of shortened tissue that effectively pull the fingers back towards the palm (the Contracture).
Why would I get Dupuytren's Contracture?
There is no known cause for the contracture, although it can tend to 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 all affected fingers being pulled into the palm and significant loss in hand function.
The two most common operations to treat this condition are:
- Fasciectomy
- This involves the removal of 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. Occasionally a general anaesthetic and overnight stay are necessary.
- Dermofasciectomy
- In some cases it is also necessary to remove the skin overlying the affected tissue. This may be because the skin is stuck to the bands/nodules of infected tissue and cannot be moved over them, or where the problem has recurred after previous surgery. The skin may also be removed in younger patients (20-40) who can be prone to further problems after a simple fasciectomy.
- In this procedure, the removed skin is replaced by skin grafted from the elbow 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 vary dramatically 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 likely to be removed).
As a result of the requirement for a splint, many normal activities, such as driving and working, may not be possible for some time after the operation. 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.
Your surgeon 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. The information included here is provided for general guidance only.
