Dupuytren's Contracture
Dupuytren’s contracture is a genetic condition, often seen in patients who have a northern European heritage.
This condition occurs when tissue deep in the palm of the hand thickens, and draws the fingers into a bent position. The fingers become stuck in that position and therefore, the use of the hand and fingers are affected. In severe cases, the finger is deeply flexed in the palm of the hand, and heavily restricts normal function of the hand.
It usually affects adults later in life, although there is a genetic condition where younger patients develop sever Dupuytren’s contractures in hands, feet and in the shaft of the penis.
Diagnosis
Diagnosis is clinical. Initially, Dupuytren’s appears as nodules in the palm. Nodules can join together, and form a cord that extends to the finger, reaching the proximal interpalangeal joint. Once the proximal interpalangeal joint is affected, the joint becomes stiff, so it is important to move quickly towards surgery to release the contracture.
An Ultrasound can locate the exact site of the contracture and localise it to the fascia.
Management
Collagenase injections are an option to treat individual fingers affected by Duputren's. Once injected into the Dupuytren’s cord, the fascia is dissolved. With hand therapy and splinting required as a follow-up to treatment.
Surgery is preferred if the disease involves several fingers, and if the disease is recurrent. An incision is made along the length of the involved finger, the skin is peeled off the Dupuytren’s cord and the diseased fascia is excised, with preservation of the nerves, arteries, and flexor tendon.
The operation can be performed under General anaesthetic.
Recovery
The wound is dressed and a plaster is applied. The patient is instructed to elevate the hand in a sling or on pillows for a few days.
A plastic bag is used to protect the dressing for showers. Some bruising is normal.
Driving is not possible because of the plaster.
Hand therapy commences at about a week, when the plaster is removed, and a night splint is fashioned, to keep the fingers in a straight extended position. During the day, the patient is encouraged to exercise the fingers as much as possible.
The sutures are normally removed after 2 to 3 weeks.
Very rarely after hand surgery a patient can develop complex regional pain syndrome (CPRS), which would need a specialised analgesia, and even more intensive hand therapy.
The Risks
Early sequelae include bleeding, wound infection, swelling and stiffness, abnormal scarring, slow healing, wound dehiscence, damage to a nerve, persistent numbness, and complex regional hand syndrome. Later complications include prolonged swelling and stiffness, complex regional hand syndrome, and recurrence.
