Dupuytren’s Disease is a thickening of the deep tissue that passes from the palm into the fingers, which causes the fingers to be bent back towards the palm over time: Dupuytren’s Contracture. It frequently affects the palm, with nodules and contractures of 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 an early 19th Century French surgeon.
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 excess alcohol intake.
A considerable amount of research is taking place to create a drug treatment for the condition. Recently the injectable drug Xiapex® a collagenase enzyme – has been developed and is now licensed in the UK (http://www.xiapex.eu/). I am at present learning how to use this for early stage Dupuytren’s Contracture. Surgery is still the mainstay of treatment once the condition becomes progressive, with finger contractures. Untreated, Dupuytren’s Contracture can result in all affected fingers being pulled into the palm and significant loss in hand function.
The three most common operations to treat this condition are:
Needle Fasciotomy Under local anaesthetic the Dupuytren’s bands in the palm are cut using a needle. This is especially suitable for elderly or infirm patients who cannot tolerate a more formal anaesthetic. Busy working people may think this is a simpler, quicker alternative, but unfortunately it is associated with a very high recurrence rate.
Fasciectomy This involves the removal of the affected tissue to correct the bent joints. The entire wound is then stitched up in a zigzag 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 years in age) 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.
Collagenase (Xiapex) injection – a staged procedure where the collagenase enzyme is injected into the Dupuytren’s cord(s) 48hrs prior to snapping these under local anaesthetic. This was available on both the NHS and privately until 2019 but has sadly been withdrawn. We hope this treatment may again become available.
Recovery times vary dramatically, depending on the severity of the condition, but a splint may be needed for some weeks after the operation, usually only at night, to maintain the surgical correction of the finger(s). At first, it will be necessary to wear the splint night and day, but this is often reduced 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 some weeks after the surgery.
As a result of requiring a splint, many normal activities, such as driving and working, may not be possible for a few weeks 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.
Prolonged stiffness of the entire hand is a possibility after any hand surgery. Dupuytren’s Disease also tends to come back and 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.
I 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