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Dupuytren’s Contracture

Dupuytren’s Contracture

Overview

This 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).

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

Surgery is done on an outpatient basis under general anaesthesia or an arm block. After the usual pre-surgical consultation and preparation we perform the procedure. During surgery, we remove the dense bands of fibrous tissue to enable the joints can to be straightened. Any shortening of the skin can be improved by incorporating ‘z-plastys’, (a versatile plastic surgery technique that is used to improve the functional and cosmetic appearance of scars) in the skin closure.  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, firm padded bandaging is applied with a splint, this is usually needed for a week after the operation. 

Note: For severe contractures, introducing Skin Grafts or Skin Flaps may be needed. 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. Please discuss any concerns you have with your surgeon.

If you would like to book a consultation, we can outline your options, and ensure that all the important details are explained and your questions and concerns fully answered.