Dupuytren’s Disease and Contracture
Dupuytren’s Disease is a benign condition of the hand, which results in tumorous thickening of palmar tissues leading to flexion contractures that limit finger motion. When this diseased tissue extends into the fingers, it begins to pull the fingers towards the palm, restricting motion. Though the condition is not painful, it may progress until the fingers become deformed or completely disabled. It is a condition usually diagnosed after age 50 and affects mainly men of European background. Often a family history of the condition can be established. Usually the natural history of the disease is a slow progression of the condition from a palmar nodule to severe finger contractures over a 5-10 year period, however is some cases the development may be more rapid. The condition may affect other body areas such as the sole of the foot (Ledderhose Disease), knuckle pads of fingers and the penis (Peyronie’s Disease). Dupuytren’s disease can be associated with diabetes, epilepsy, alcoholism, and chronic lung disease but the reasons why are unknown.
Treatment – Alternate Therapies
Although most reconstructive hand surgeons believe that surgery is the most effective and definitive treatment modality for Dupuytren’s Disease, in recent times other currently unsubstantiated treatment modalities have been offered, particularly for less severe disease. It is generally accepted that hand therapy involving massage and splinting is not effective in preventing the progression of early Dupuytren’s Disease. However recently attempts at treating the disease with “collagenase” injections (to chemically break down the collagen Dupuytren’s bands) is being trialled to test its efficacy. Although these injections have shown some initial promise delaying the need for surgery early experience indicates they may not be effective as a definitive treatment modality. The other alternative treatment modality of needle fasciotomy to release the contracture bands without surgical incisions has proved effective in the short term with a more rapid recovery, but has a high incidence of recurrence requiring further surgery in the future. Most recently this treatment has been complemented with fat transfer to the hand in the hope that stem cells in fat will decrease the recurrence risk.
Treatment – Hand Surgery
The only effective and definitive treatment for advanced stage contracture of the fingers due to Dupuytren’s Disease is hand surgery. Because important digital nerves may become intertwined with diseased collagen tissue in the palm, surgical procedures to correct contractures are best undertaken by a reconstructive plastic surgeon, with experience in skin flaps, skin grafts and microneural surgery. Dr David Ross will undertake a full assessment of the hand and digital contractures and describe the appropriate technique to achieve the most functional outcome. The goal of contracture hand surgery is to increase the motion of affected fingers by removing the thickened Dupuytren’s tissue and releasing the tendons to allow normal movement once again. The procedure is usually undertaken as a day surgery case under an arm block or general anaesthesia, however more severe cases may need an overnight stay. With an inflated tourniquet, incisions are made longitudinally in the palm along the affected fingers and skin flaps are elevated exposing the underlying structures. With special care not to damage important structures in the palm (nerves, blood vessels and tendons), the diseased Dupuytren’s collagen bands are carefully dissected and removed and then the interphalangeal joints are released to allow normal digital motion. The palmar wounds are then closed using local skin flaps and possibly skin grafts to minimise the possibility of recurrent contracture.
After surgery, patients can expect to see a significant improvement in their finger position and mobility. The usual postoperative course would involve 2 weeks in a protective dressing and splint until the wounds had healed and then 2-4 weeks of hand therapy to return to full hand function and grip strength. More significant contractures will require a more prolonged postoperative rehabilitation program.
To determine if you would benefit from surgery for Dupuytren’s disease, schedule a hand surgery consultation with plastic surgeon David Ross. Contact our Melbourne plastic surgery practice today to make the arrangements.