Dupuytren’s contracture is a condition which causes the fingers to bend towards the palm and unable to fully straighten. It is caused by a thickening of the tissue underneath the palm. The thickened tissue causes lumps and cords which tightens the tissue and thus pulls the fingers towards the palm. Dupuytren’s disease is often genetic but there are other causes and the progression of the disease is often unpredictable.
The usual operation for Dupuytren’s contracture is called palmar fasciectomy. This procedure is usually performed as a day-case, which means no overnight stay in hospital in necessary, under either general or local anesthetic. The patient will have a tourniquet put around the upper arm to control bleeding. The surgeon will make an incision into the fingers and palm to remove the affected tissue which will allow the fingers to relax into their normal position.
If the skin is also affected by Dupuytren’s disease a skin graft may also be necessary. Skin will be taken from another part of the body to replace skin on the hand. Other treatments for Dupuytren’s include injecting an enzyme called ‘collagenase’ to dissolve some of the affected tissue. This is only suitable for some types of Dupuytren’s. A fasciotomy involves cutting through the cords under the palm through a small incision, again this is only suitable for some types of Dupuytren’s.
In most cases the cuts are stitched together in a zigzag to allow the fingers to move freely. It is likely the patient will experience some pain and discomfort for a few days following the procedure. The hand will also likely to be swollen and bruised which should settle down in two to three weeks.
A palmar fasciectomy is considered to be a safe operation, however all surgery carries an element of risk. Though surgery can help to improve the flexibility in your fingers, it does not stop the process of Dupuytren’s disease. So the contracture may return, requiring another operation.
In rare cases the hand can become stiff and painful after surgery requiring physiotherapy. In severe cases patients may be unable to fully straighten their fingers and will need splints to improve their results. Nerves in the fingers may be damaged, this is more likely in a repeat fasciectomy. It may be possible to repair the damage with further surgery. In very rare cases a finger may be lost, this is more likely in patients who have either had lots of previous surgery or a condition that affects their blood circulation such as diabetes or they are a smoker.