Dupuytren's contracture is hand condition where your fingers are bent towards your palm and cannot be fully straightened. It occurs when tissue in your palm thickens and can pull your finger towards your palm. It may be treated by an operation to remove affected tissue.
Dupuytren's contracture often runs in families and factors including smoking, diabetes and taking certain medications may trigger the condition, if you have the gene for it. The condition affects men more than women, with most cases in men over 50 and women over 60.
Your doctor may suggest surgery if other treatments have not helped you.
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You will have a formal consultation with a healthcare professional. During this time you will be able to explain your medical history, symptoms and raise any concerns that you might have.
We will also discuss with you whether any further diagnostic tests, such as scans or blood tests, are needed. Any additional costs will be discussed before further tests are carried out.
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Our dedicated team will also give you tailored advice to follow in the run up to your visit.
We understand that having surgery can potentially be a time of anxiety and worry. Our experienced and caring medical staff will be there for you every step of the way.
The usual operation for Dupuytren’s contracture is called palmar fasciectomy. It may be performed under general anaesthesia, which means you'll be asleep throughout the procedure, but it can also be done under regional anaesthesia, which means you'll be awake but your hand will be numb. The operation involves the removal of a section of the tissue (the fascia) under the skin on the palm of the hand.
During the procedure, a tourniquet is put around your upper arm to control bleeding during the operation. Your surgeon will then make incisions into your affected fingers and palm to remove the affected tissue and allow the fingers to relax into their normal position.
In most cases, the surgeon will stitch the cuts together to create a zig-zag scar that heals to allow the fingers to move freely. Sometimes stitches are not used because some surgical incisions heal better without them, causing less scarring and discomfort.
If your skin is also affected by Dupuytren’s disease, your surgeon may need to remove some of it. If this happens, you may need a skin graft, and skin will be taken from another part of the body to replace skin on your hand. This is a more complicated operation known as dermofasciectomy.
You will usually have local anaesthesia injected around the operation site so that your palm and fingers are numb and you will not be in pain immediately after the operation. The operation may take an hour or more, depending on how many fingers are involved.
Wide-awake hand surgery or WALANT
Wide-awake hand surgery or WALANT (Wide Awake Local Anaesthetic No Tourniquet) is a surgical technique allowing the surgeon to operate on your hand while you're awake. By injecting lidocaine (local anaesthetic) in combination with epinephrine (adrenaline) into the hand, it avoids the need for general anaesthetic and helps to control bleeding so a tourniquet isn’t required which reduces pain during the procedure.
The procedure allows real-time feedback to the surgeon during the operation on the movement of the hand. Using local anaesthetic can reduce the risk of potential surgical side effects and complications and get you back to your normal activities faster with a quicker recovery.
A palmar fasciectomy operation can be performed as a day case, but you may need to spend one night in hospital.
After this, you will be taken to your room or comfortable area where you can rest and recuperate until we feel you’re ready to go home.
While you are in hospital a physiotherapist will help you with exercises that will help speed up your recovery.
Once the local anaesthesia wears off, it is likely that you will have some pain or discomfort for a few days.
Your hand will probably be swollen and bruised after the operation, but this should settle down in two to three weeks.
The scar may be tender for a couple of months and the surrounding skin may become very dry. This can usually be relieved with a moisturiser.
Although surgery can help to improve the flexibility in your fingers, it does not stop the process of Dupuytren’s disease. The contracture may return and require another operation.
Once you’re ready to be discharged, you’ll need to arrange a taxi, friend or family member to take you home as you won’t be able to drive until advised by your surgeon.
Even after you’ve been discharged, we’re still looking after you every step of the way. After Dupuytren's contracture surgery, we will provide you with all the appropriate medication, physiotherapy exercises, advice on what to do and not to do with your hand and follow-up support.
Typically your consultant will want to see you after your treatment to see how you’re doing. You might also be seen by a physiotherapist if your hand becomes stiff and painful. A follow up appointment will be made before you leave the hospital or clinic.
On rare occasions, complications following Dupuytren's contracture surgery can occur.
The chance of complications depends on the exact type of operation you are having and other factors such as your general health. We will talk to you about the possible risks and complications of having this procedure and how they apply to you.
If you have any questions or concerns, we’re ready to help.
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The treatment described on this page may be adapted to meet your individual needs, so it's important to follow your healthcare professional's advice and raise any questions that you may have with them.
Procedures carried out at one of our Spire Healthcare Clinics will be performed under local anaesthetic.
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