Dupuytren disease (or Dupuytren contracture) is an abnormal thickening of the tissue just beneath the skin of the palm, which can sometimes extend into the fingers.
The skin may develop pits, bumps and cords (thick lines) which can cause the fingers to bend into the palm and stop the finger from straightening completely.
Very occasionally Dupuytren disease can also cause thickening on top of the knuckles or cause lumps and cords on the soles of the feet (plantar fibromatosis).
The cause of Dupuytren disease is largely unknown, but there is increasing evidence that it is due to your genetics, or DNA. It is more common in men, people over forty years of age, and in people of European descent.
Dupuytren disease can affect people very differently, so there are many different treatment options.
Some people have only slightly bent fingers or thumbs that cause no functional problems, and therefore may not need any treatment.
Other people may have more severely bent fingers or thumbs that make it difficult to complete some tasks, and may benefit from some form treatment to improve their function.
Treatment to help straighten the digits can range from injections of medications, to using needles to weaken the cords causing the bends, or an operation to remove the cords completely.
Dr Colbert will discuss the different risks and benefits of each treatment option during your consultation.
Surgery to simply cut the abnormal cords (and not remove them) is called a fasciotomy, while surgery to remove the abnormal cords is called a fasciectomy.
These operations are performed as day surgery, meaning you don’t need to stay overnight at the hospital. An anaesthetist will give you either a regional or general anaesthetic.
Under sterile conditions and using microsurgical magnification glasses Dr Colbert will cut or remove the abnormal cords of tissue from your hand, while ensuring that the surrounding nerves and vessels and tendons remain undamaged.
In most procedures the tight skin is closed by rearranging it, but in some cases a skin graft may be required.
As the treatment options for Dupuytren disease can vary, so to can the recovery. In general though the more extensive your surgery is then the longer your recovery time will be.
Hand therapy will be required after your operation to improve the function and range of motion of your hand. This may include hand therapy exercises supervised by a specialist hand therapist, and sometimes hand splints are used.
Driving is possible once you are safely able to perform an emergency stop in your car, and usually this takes one to two weeks.
Returning to work depends on what operation you had and the nature of your job. Patients with office jobs who had a fascioctomy may return to light duties after several days, while patients with a physical job and who had a skin graft may need several weeks away from work.
Dupuytren disease surgery is associated with the following risks:
Infection, bleeding and bruising, wounds taking longer to heal, and stiffness are risks associated with all types of hand surgery.
Nerve or vessel injury: as the Dupuytren cord can wrap around the nerves and vessels in the hand and finger, there is a very small risk of damage to these structures. While this damage can be repaired during your operation, Dr Colbert reduces the risk of this happening by performing all Dupuytren surgery using microsurgery magnification glasses or loupes.
Recurrence: Dupuytren disease is thought to be a genetic condition, which means that your own individual DNA puts you at risk for the contracture coming back after surgery. The risk of this recurrence depends on multiple factors, including your age, family history of Dupuytren disease, severity of Dupuytren disease, and type of surgery you have.
Dupuytren disease surgery, like any surgical procedure, carries risks and therefore before proceeding you should always seek an opinion from an appropriately qualified health practitioner.