- Could be genetic
- Diabetes mellitus
- Chronic alcoholism
- Anti-epileptic drugs, smoking
- Chronic lung disease
- Mildly painful nodules in the palm
- Bending of fingers
Surgery is recommended
- If the thickening and pulling on the fingers continues to increase
Kinds of Surgeries
What is Dupuytrens Disease?
Dupuytrens disease is a benign progressive condition which affects the fascia on the palm of the hand and fingers. Fascia is the tissue that lies just below the surface of the skin of hand and extends into all of the fingers. This disease leads to thickening of the fascia/fibrous tissue which then pulls on the fingers causing them to bend towards the palm. Patients may notice a lump/nodule, indentation in the skin or thickening in the palm or fingers. It usually affects the small and ring fingers but can involve any other finger or thumb.
What causes Dupuytrens Disease?
It is not known but research has shown that there may a genetic link as it is most common in people of Northern European decent (Vikings disease). It also has association with diabetes mellitus, chronic alcoholism, anti-epileptic drugs, smoking and chronic lung disease.
It usually happens in males between the ages of 50 and 70 years of Caucasian origin. Rare in blacks and Asians.
What are the symptoms of Dupuytrens Disease?
People will usually have mildly painful nodules to begin with; in the palm which can then progress and cause bending of the fingers.
It can result in difficulties of day to day activities like putting hands in pockets, shaking hands; difficulties in gripping and people poke themselves in the eye.
The same scar tissue can also go on to form in the foot and the penis.
If left untreated the disease can progress to fingers and the affected finger can become more bent. Eventually you may lose the function of the involved finger or even the entire hand.
Why should I have surgery for Dupuytrens Disease?
Most patients do not need treatment especially if the disease progresses slowly and has not caused any deformity or function lost. However, surgery is recommended if the thickening and pulling on the fingers continues to increase and you are unable to do daily activities like shaking hands, washing your face, putting hands in your pocket or wearing gloves etc.
This is all because changes in the fascia in the palm will not go away on its own and will cause problems with deformity and function loss.
Lumps or the thickening has to be surgically released, excised and removed. It allows fingers to move away from the palm of your hand and gives you a good function.
What happens during Dupuytrens Surgery?
There are different types of surgery which will be catered to your individual needs. It can be carried out under local, regional or general anaesthetic. This will be discussed with you at the time of your clinic appointment.
Some of the common options are:
- Fasciectomy – in this you get a zigzag incision. All the diseased fascia is removed and surgical correction is achieved
- Fasciotomy – done under a local anaesthetic and the fascia is cut with a needle. This is done in the early stages or for people that cannot undergo general anaesthetic.
- Dermofasciectomy – In some severe cases of Dupuytrens disease along with fascia; skin is also removed. This is then replaced by a skin graft which is taken from the arm.
Are there any alternatives to surgery?
In the early stages when the thickening is only minimal some people may benefit from night splints and finger hand therapy. Splints will hold your fingers straight whilst you sleep.
An enzyme injection where an enzyme collagenase is injected into the thickened fascia/cord. Then your surgeon will manipulate your fingers and hand after 24-48 hours. This will break the thickened cord in the hand and the fingers will become straight. This is usually done under a local anaesthetic.
Are there any risks with this surgical correction?
There are very small risks like with any surgery which are infection, recurrence, damage to digital nerves and vessels, temporary pins, needles and numbness to the fingers because of stretching or bruising to the nerves, actual damage to nerves and vessels, sloughing and necrosis of the wound edge.
On the whole results are very good with a good return of function to the hand with minimal serious complications, less than 1%.
What should I look out for at home?
- Dizziness and tiredness – if you had a general anaesthetic you might feel dizzy and tired. Anaesthetic will take up to 24 hours to wear off.
Gently moving around within your home helps with blood circulation and helps with blood clots.
- Swelling in the hand and fingers – this can be alleviated by keeping your hand up in a sling and gentle movement of your fingers.
- Dressing – you will leave hospital with a padded dressing and a plaster slab. You will be seen back in clinic in two weeks’ time for a wound check, removal of sutures and plaster. Then you will be given a plastic splint and you will be seen by a hand therapist for further post op rehabilitation.
Postoperative advice following open surgical release of Dupuytrens contractures
- Swelling – to minimise the swelling elevate your hand in a sling and at night; using a pillow. Move your shoulder, elbow, wrist and your unaffected fingers every hour.
- Pain control – You will be given pain killers which you should take before you do your exercises
- Wound care – Keep your wound dry for approximately up to two weeks and you will be seen in the hospital for removal of sutures
- Scar – Once the wound has healed scar massages should commence which will be advised to you by your hand therapist.
- Exercises – You will be seen by your hand therapist who will give you a splint and show you exercises to your fingers, elbow, shoulder and wrist. It is important to keep moving all the joints to prevent stiffness.
55 years male Severe Dupuytren’s Contracture specially to little finger
ADL ( activities of daily living affected )
Dupuytren’s scar tissue shown ( held in instrument )
Digital nerves to finger shown Good correction achieved to little finger
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