What is Dupuytren's disease?
Dupuytren’s disease or Dupuytren’s contracture is a condition where scar-like tissue forms around the tendons right underneath the palm of the hand, which are allowing the fingers to grip. Over time, this tissue continues to thicken and if the disease progresses significantly, the hand will not be able to extend your fingers.
The first symptoms of Dupuytren’s contracture are the growth of small lumps in the palm of the hand, thickness of the skin and tenderness around the palm. The first finger to be affected is the ring finger, followed by the middle and little finger.
Undergoing surgery for Dupuytren’s disease will allow fingers to be straighter and your hand will be functional again.
Are there any alternatives to the surgery?
Some mild forms of the disease can be treated non-surgically with either radiation therapy or injections. The injection uses a newly available medicine that dissolves the bands of tight tissue but this is not appropriate for all affected hands. Find out more about the injection treatment.
What will happen during my hand surgery consultation?
When you meet with your consultant surgeon they'll ensure that you have the opportunity to ask any questions you may have about your hand surgery, they'll discuss with you what'll happen before, during and after the procedure and any pain you might have. Take this time with your consultant surgeon to ensure your mind is put at rest.
What does hand surgery for Dupuytren's disease involve?
Your consultant will explain the options of surgery that are suitable for you – this will depend on the severity of your contractures. This procedure removes the diseased tissue from your palm and digits with the intention of allowing full straightening. Achieving a full correction depends on factors such as the severity of your angle of contracture, the other tissues involved, the length of time the digit has been bent and your post-operative rehabilitation.
There are a variety of different techniques under the umbrella term of fasciectomy. Some are simpler and involve taking away only the diseased fascia under the skin, but sometimes it is necessary to remove the skin as well and a small skin graft will be used to cover the affected area. Your surgeon will talk you through your options and help you decide which is the most appropriate for you.
What is Fasciectomy?
This procedure removes the diseased tissue to allow the digits to straighten again. Achieving a full correction depends on a few factors including the timing of the surgery in terms of your disease. A fasciotomy is carried out to treat more severe cases and it is more effective in the long term but also has more risks.
There are a variety of different ways a fasciotomy can be carried out: regional, segmental and dermofasciectomy. The surgery is carried under regional anaesthetic, and it can be performed as an outpatient procedure. Your surgeon will give you more information about the types of treatment that could work for you and whether they think a full correction is achievable.
What is needle Fasciotomy?
Needle fasciotomy or needle aponeurotomy has had considerable publicity in recent years. It is only appropriate for very specific presentations of Dupuytren’s in the palm of the hand, as it is unsafe and ineffective in the fingers. Your surgeon will be able to advise you whether your Dupuytren’s can be managed with this procedure.
With needle fasciotomy your recovery time will be quicker and there are lower risks of complications. It is recommended to people who are not able to have a more extensive surgery. However, the recurrence rate for Dupuytren's after a needle fasciotomy is quite high, with about 60% of people experiencing it after 3 to 5 years.
What complications can happen?
Any intervention presents a risk of general complications such as pain, bleeding, infection of the surgical wound and scarring.
Specific risks of the surgery for Dupuytren’s are:
- Injury to the small arteries in a finger
- Incomplete correction of the Dupuytren’s contracture
- Stiffness of the finger joints
- Wound-healing problems
- Rarely, a pain syndrome can result which may cause loss of use of the hand. This is a complication of all hand surgery and not specific to this condition.
Any risks will be discussed in full with the consultant surgeon ahead of the procedure.
How soon will I recover?
You should be able to go home the same day but occasionally a one night stay is recommended.
Post-operative hand therapy and specific exercises will ensure that you make a good recovery and minimise the scar tissue. This is very important as healing scar tissue can also make the fingers contract again. Once you have had surgery or injection treatment you still have Dupuytren’s disease and therefore there is always a chance of the contracture recurring.
You may be required to wear a hand splint in the beginning, especially during night time.
It can take some time for your hand to settle down after surgery, especially if you had a fasciotomy. The scars can be fairly thick at first.