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Dupuytren

Dupuytren's Contracture

Dupuytren's Contracture is a condition of unknown cause in which the tissues under the skin become thickened and scarred. Gradually this causes puckering of the skin of palm and inability to straighten one or more fingers.

The condition is slowly progressive and may take several months to years to become severe enough to cause problems. In severe cases the finger is permanently bent almost touching the palm. The commonest finger involved is the ring finger followed by the little finger.

The condition is common in people of Northern European origin. Because it is rarely painful, help is often sought quite late when the deformity of the finger is fairly advanced.

Treatment

Surgery is the only effective treatment to correct the deformities involving fingers. Some people have very mild form of Dupuytren's contracture and the condition does not always progress to cause finger deformity. Early surgery does not guarantee that future recurrence or progressive deformity will not take place. It is for these reasons that early surgery is not recommended.

When should I seek Treatment?

If you have this condition but you are able to straighten your fingers then it is better to keep checking your hands. One way to find this out is to put your palm flat on a table. If your fingers and palm cannot be placed completely flat on the tabletop then you should seek advice.

As suggested above, very early surgery is not recommended but once the finger deformities have started then treatment should be sought early. Results of surgery are better when the deformities are mild. In very severe deformities of fingers the correction after surgery may not be complete.

Operation

Surgery involves removing the tissues that is causing the problem. Nerves to the fingers have to be protected during operation. There is about 1% risk of damage to these nerves during operation, which may leave a numb patch in your finger. Even when the nerves are undamaged, there may be a short period when you get pins and needles in the finger.

Sometimes the skin in the palm or the finger is too closely involved by the condition and has to be removed with the affected tissue. If this happens, a skin graft might be needed. The skin graft is done by transplanting a piece of skin usually from your arm to the affected site. Your surgeon will explain this to you if necessary.

Will I need joint surgery?

Sometimes the joints themselves have become very stiff and despite surgical removal of the offending tissue the correction of finger is not satisfactory. In these cases joint release is carried out and metal wires may have to be inserted to keep the finger straight in the healing period. A splint may also be used once the wires have been removed.

Open Palm technique

Sometimes after correction of the deformity of fingers, the wound cannot be closed without tension. If this happens the wound in the palm is left open to heal gradually. The healing time is prolonged to a few weeks but the end result is much more satisfactory. The final scar, which results, is no different from one left by a wound that is stitched.

Results

Generally the results are better if the deformity is mild. Once the middle joint of the finger is severely affected the correction after surgery is not total.

Recurrences after surgery are common but usually they are not severe enough to require further surgery.

Results of recurrent surgery are less satisfactory and often require skin grafts.

Amputation of the digit becomes rarely necessary in recurrent cases.

What to expect

The surgery is usually done as a day case under general anaesthetic. There may be medical condition requiring you to stay overnight.

After surgery your hand will be wrapped up in a bulky dressing with your fingers comfortably straight. Circulation in your finger will be checked before you are discharged home. Make sure that you are comfortable and your fingers are warm and pink. You may require painkillers.

Arrangements will be made for you to return in about three to four days for a change of dressing. You can start exercising your finger as early as possible.

Stitches are removed on about the tenth day after surgery. Keep your hand dry till the stitches are removed.

Physiotherapy and appointment with the occupational therapist is arranged for you. This is to help with swelling, movements and wound management as well as the use of splints when necessary.

Dupuytren

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