Dupuytren’s Contracture

Overview

Dupuytren’s Contracture is a common hand condition in which dense fibrous tissue under the skin of the palm grows like a benign tumour. This tissue commonly grows along the line of the ring and little fingers starting in the palm, producing skin nodules and pits, often across the crease of the palm. It may extend down into the fingers past the first joint, bending the fingers toward the palm. In severe cases the little and ring fingers may become hooked and virtually immobile.

In rare cases, nodules can occur in the soles of the feet, or in Peyronie’s disease (a related condition), the shaft of the penis.

Dupuytren’s disease often runs in families with western European Celtic origins. The exact cause is not known, and there is no absolute cure, but surgically treating the hand before the joints bend more than about 20° has the greatest chance of success (severe contractures often can be improved but not corrected completely).During surgery of Dupuytren’s Contracture, we remove the dense bands of fibrous tissue so that the joints can then be straightened, any shortening of the skin can be improved by incorporating ‘z-plastys’ in the skin closure. Firm padded bandaging is applied with a splint, usually for a week post-operatively.

Surgery is done on an outpatient basis under general anaesthesia or an arm block. Treating the wound with steroid before closure may help prevent further fibrosis, particularly in severe cases. Following surgery, the hand is put in a high sling to reduce swelling. Removing smaller deposits of fibrosis under local anaesthetic is becoming popular, being quick to do. For severe contractures introducing Skin Grafts, or Skin Flaps may be required. In very advanced cases when the fingers are bent into the palm and there is non-reversible joint contracture, amputation of the fingers may be appropriate!A wound check and dressing change are done at one week,  sutures are removed after two weeks. Your surgeon may recommend a rehabilitation programme under the guidance of a Hand Therapist. Using the hand for light work after suture removal at two weeks is usually possible.

Review by the surgeon is usually done 2-3 months after surgery. Ongoing surveillance over the ensuing years may be necessary as Dupuytren’s contracture is not curable and it may occur in other parts of the hand requiring further surgery sometime in the future.

Best Candidates

• People with progressive nodule & contracture band formations
• People with inability to fully straighten the knuckle joints or first/second finger joints

What to Expect

Dupuytren’s Contracture is a common hand condition in which dense fibrous tissue under the skin of the palm grows like a benign tumour. This tissue commonly grows along the line of the ring and little fingers starting in the palm, producing skin nodules and pits, often across the crease of the palm. It may extend down into the fingers past the first joint, bending the fingers toward the palm. In severe cases the little and ring fingers may become hooked and virtually immobile.

In rare cases, nodules can occur in the soles of the feet, or in Peyronie’s disease (a related condition), the shaft of the penis.

Dupuytren’s disease often runs in families with western European Celtic origins. The exact cause is not known, and there is no absolute cure, but surgically treating the hand before the joints bend more than about 20° has the greatest chance of success (severe contractures often can be improved but not corrected completely).During surgery of Dupuytren’s Contracture, we remove the dense bands of fibrous tissue so that the joints can then be straightened, any shortening of the skin can be improved by incorporating ‘z-plastys’ in the skin closure. Firm padded bandaging is applied with a splint, usually for a week post-operatively.

Surgery is done on an outpatient basis under general anaesthesia or an arm block. Treating the wound with steroid before closure may help prevent further fibrosis, particularly in severe cases. Following surgery, the hand is put in a high sling to reduce swelling. Removing smaller deposits of fibrosis under local anaesthetic is becoming popular, being quick to do. For severe contractures introducing Skin Grafts, or Skin Flaps may be required. In very advanced cases when the fingers are bent into the palm and there is non-reversible joint contracture, amputation of the fingers may be appropriate!A wound check and dressing change are done at one week,  sutures are removed after two weeks. Your surgeon may recommend a rehabilitation programme under the guidance of a Hand Therapist. Using the hand for light work after suture removal at two weeks is usually possible.

Review by the surgeon is usually done 2-3 months after surgery. Ongoing surveillance over the ensuing years may be necessary as Dupuytren’s contracture is not curable and it may occur in other parts of the hand requiring further surgery sometime in the future.