Dupuytren’s Contracture
The hand has tissue within it called fascia. This fascia helps to stabilize the palmer skin. In some people this fascia begins to tighten and contract and can cause the fingers of the hand to become permanently bent. The disease often starts as nodules in the palm which then progresses to the fingers.
Dupuytren’s contracture consultation
involves a discussion of the patient’s heritage as the condition is more common in people of Celtic, Scandinavian or Northern European descent. Questions about other areas of the body may be relevant as sometimes Dupuytren’s Disease can affect the feet or penis. Examination looks at the degree of contracture is present. If the patient cannot place the palm flat on a table then this is a good indication that surgery is required. Final outcome is often determined by the timing of surgery. If surgery is left too late then changes occur in the joints that prevent a full return of function.
Dupuytren’s contracture Surgery
is preferably done under general anaesthetic or arm block (patient is awake but the arm is put “asleep” by an anaesthetist). A tight cuff is placed around the arm to stop the blood while operating. Zig-zag cuts are made over the bands of contracture and the fascial bands are excised. The skin is then closed. Occasionally, if the Dupuytren’s Contracture is severe, a skin graft may be inserted. A bulky bandage is then applied.
After Surgery
the patient must keep their hand elevated. The patient may be able to go home the same day or sometimes they stay a night in hospital. It is advisable that someone else is with the patient for the first night. Prescribed pain medication is taken for pain relief. The patient should keep their hand elevated as much as possible. Bandages are removed after 1 week and sutures removed after 2 weeks. Depending on the severity of the disease and the extent of surgery a course of physiotherapy may be undertaken.