| Dupuytren’s
Contracture
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 bent back towards the palm over time. It
frequently affects the little and ring fingers, but may affect any
fingers (or thumbs) of either hand.
It may also affect the soles of the feet.
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).
Dupuytren was a French surgeon of the early 19th Century.
Why would I get Dupuytren’s Contracture?
There is no known cause for the contracture, although it
does 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 progressive with finger contractures. Untreated, Dupuytern’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 in the palm may be left open
to facilitate physiotherapy and will 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 affected 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 or groin.
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). You will be under
the care of my Hand Therapist for weeks after the surgery.
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.
Potential pitfalls
Prolonged stiffness of the entire hand is a possibility after any
hand surgery. Dupuytrens disease also tends to come back to affect
either the operated finger(s) or other fingers after surgery. The
time-span for this is variable and not consistent.
Injury to the small nerve(s) supplying sensation to the tip of
the finger pulp is a rare complication of surgery.
Mr Fleming 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.
How
to book an appointment
Disclaimer
|
