Dupuytren’s Contracture
A hand disease with an unknown cause consisting in hypertrophy of the connective tissue (fascia) of the palm. The first nodules usually appear after attaining 50 years of age. Over time, the progressing overgrowth leads to pathological changes of the fibrous brands and contracture of the finger or fingers. Inability to extend even one finger results in substantial reduction of the functionality of the entire hand, affecting the overall fitness and quality of life of the patient.
In the recent years, local collagenase injection has become popular in treatment of the Dupuytren’s disease / contracture. This solution is, however, not suitable for every clinical case. There is also no research presenting its distant results. Therefore, the dominant treatment method is surgery.
FREQUENTLY ASKED QUESTIONS
It is assumed that surgical treatment is to be carried out in the advanced stage of the disease, i.e. in case of flexion contractures, limitation of extension or flexion capability or symptomatic compression of the neurovascular pedicle. To simplify, it may be assumed that an indication for surgery is the inability of full extension of the palm on a flat surface. We distinguish two surgical methods: fasciotomy and fasciectomy.
Fasciotomy is a little invasive procedure performed under local anaesthesia, consisting in performance of a series of punctures of pathological strips of the connective tissue to weaken and tear them.
This procedure is usually used as a form of ad hoc improvement of hand functioning and its preparation for a more extensive
surgery.
A relatively new method of treatment of the Dupuytren's disease is rigotomy combined with the patient's fat graft. A series of tunnels, by means of a umber of punctures, is made in the pathological connective tissue strips, to them fill them with a fat graft.
Although there is no research presenting distant results, the above method seems to be an alternative for excisional surgery procedures.
The surgery consists in removal of pathological connective tissue strips of the hand. Due to its extensive and invasive nature, the procedure is performed under regional or general anaesthesia (depending on the scope of the planned excision).
The treatment method is selected individually for every clinical case. During the consultation appointment, I collect detailed medical history and perform physical examination. Based on the obtained information, I present the available treatment options to the patient, depending on the specific case.
Depending on the applied anaesthesia and extensiveness of the performed surgery, the patient is discharged on the day of the procedure or on the next day. In the case of fasciectomy, the patient is obliged to report for a check-up on the next day.
Swelling and mild/moderate pain ailments of the hand may persist for several days after the procedure. Any potential pain ailments are mild and can be treated with OTC pain relievers.
Elevation of the hand operated on is recommended for 2 weeks after the procedure. The hand is immobilized in a split for 3
weeks. The wound healing time depends on the type and scope of the surgery, and ranges from 2 to 3 weeks.
After the wounds are healed, it is recommended to commence intensive rehabilitation of the hand operated on. Returning to
sport professional activity is usually possible after 3-6 weeks in the case of fasciotomy and ca. 6-12 weeks in the case of
fasciectomy.
The exact etiology of the Dupuytren's disease is unknown. All available therapies are symptom and not cause-based.
Additionally, the course of the disease itself is unpredictable. Research shows that the percentage of disease recurrence ranges, depending on the source, from 30% to 60%. The contracture may also develop in another finger or in the opposing hand.