Problem
- Curling down of the fingers into the palm due to cords of fibrous tissue
Cause
- Cords of fibrous tissue form beneath the skin and they track down into the fingers causing contractures to develop.
- There is usually a strong family history and people tend to come from Celtic ancestry
Diagnosis
- Usually the contractures are obviously caused by cords of tissue and simple examination of the hand will confirm the diagnosis of Dupuytren’s
- A positive family history is usually obtained.
- The patients have difficulty washing their face due to the contracture, difficulty placing their hands in their pockets and usually unable to get their hand flat on the table.
Treatment
- Mainstay of treatment is surgical
- Under general anaesthetic
- Usually done as a day stay procedure
- Skin incisions are made over the palpable cords and the diseased tissue is removed.
- ‘Z’ plasties are performed to break up the line of the scar
- Occasionally skin grafts are required to replace contracted skin
Needle aponeurotomy can be performed for mild cases in the palm, usually done under sedation in a sterile operating theatre.
Collagenase injections are being trialled overseas and are likely to be available in New Zealand within the next one to two years; however their use remains restricted to predominantly palmar disease.
Potential Complications
- Infection, haematoma, neurovascular injury, post-operative stiffness, recurrence of contracture
- In revision cases, amputation of the digit may be required.
Post Op Care
- Patient is discharged in a plaster slab, keeping the fingers in extension for the first few days
- Referral to hand therapy for active mobilisation, + or – splinting for up to three months.
- Wounds are reviewed at ten days and usually dissolving stitches are utilized, so not necessary to be removed.
- Scarring in the hand softens between three to six months post operatively.
