Dupuytren’s Contracture

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What is Dupuytren’s Contracture?

It is a contracture of the normal fibrous layer of tissue in the palm. It frequently runs in families and there is higher incidence in people who suffer from epilepsy, diabetes and alcoholic liver cirrhosis and who smoke.

What are its features?
The disease usually starts as firm nodules in the palms of the hands which progress to form hard bands or cords which are likely to extend from the palm to the fingers, leading to deformity and difficulty straightening the fingers. It is not usually a painful condition. Firm nodules can develop on the back of the fingers (knuckles pads) and can also rarely affect the soles of the feet where painful nodules develop.

Does it affect all the fingers?
The disease can affect any of the fingers of either hand but the most common to be involved are the little and ring fingers. The disease affects both hands in about 60 per cent of cases and the thumbs are occasionally involved.

Can this disease be related to my work?

What are the treatment options for this disease?

1. Fasciotomy – this is an operation under local anaesthetic to divide the tight bands which cause flexion or bending of the knuckle joints. It is rarely recommended since the recurrence rate is very high following this procedure.
2. Fasciectomy with or without skin grafting – this entails surgical excision of the disease from the palm and the affected digits. It is recommended when the finger joints are bent over 30 to 40 degrees – some of these wounds may be left open and allowed to heal with regular dressings over a period of 2-3 weeks.
3. Amputation – Rarely required for extreme contracture.

For how long will I be unable to use my hand after surgery?
1. Following division of the band under local anaesthetic (fasciotomy) you will have a bandage on your hand for about five days.
2.After surgical excision (fascietomy) three to four weeks. During this period you should not drive or do any manual activity that is likely to cause pressure or friction on the bandage.

Will I need any further treatment?
Following surgical excision and skin grafting (fascietomy) you will require exercises from a hand therapist and possible splinting for about 6 months. You will require review until the finger(s) fully heal.

Can the operation do me any harm?

Anaesthetic: Rarely problems can occur related to your general health. The potential problems should be picked up at the Pre-Assessment Clinic. Your anaesthetist will be able to discuss this further with you.
Wound Healing: This usually takes between 2-4 weeks and requires dressings until the wound has fully healed but may take longer.
Nerve Injury: The nerves to the fingers are involved with the Dupuytren’s bands and during release may be damaged. This is usually a temporary numbness in the finger (s), but rarely can it be permanent.
Incomplete correction of deformity: In more severe or longstanding deformity, full correction of the deformity is unlikely and you will be advised of the likely degree in your case.
Recurrence: This is very common whatever procedure is performed, but less likely if skin grafting is used. It may affect the same finger or other fingers in the hand.

What happens next?
Your name will be placed onto the waiting list. You may be required to attend for a pre-assessment before your operation.
• Pre-assessment – to make sure you are well enough for the operation. You will also receive more information about the arrangements for coming into hospital and what you will need to bring
with you.

If, whilst on the waiting list, you feel you no longer need this operation speak to your family doctor in the first instance and secondly let the Admissions Office at the hospital know by calling telephone number 01908 996798.