Dupuytren's disease
What is Dupuytren's disease ?
Dupuytren's disease is a benign condition affecting the connective tissue of the palm.
It causes progressive thickening and contracture of the palmar fascia, the fibrous layer beneath the skin of the palm, which gradually forms cords that draw one or more fingers into a fixed flexed position toward the palm.
The ring and little fingers are most commonly affected. The condition progresses slowly over several years and is more prevalent in men over 50. A family history, alcohol consumption and diabetes are recognised risk factors.
When is surgery needed ?
There is no medical treatment capable of halting the progression of Dupuytren's disease. Surgery is indicated when the contracture becomes functionally limiting, in particular:
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when the deformity exceeds 30 degrees at the metacarpophalangeal joint
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as soon as the proximal interphalangeal joint is involved, as contractures at this level become rapidly fixed without surgical treatment
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Early intervention is important : longstanding and severe contractures are more difficult to correct.
How is the procedure performed ?
The procedure is performed under regional anaesthesia on a day-case basis (the patient goes home the same day).
A fasciectomy is carried out: the thickened fibrous cords in the palm and fingers are excised through carefully planned incisions. The digital nerves and vessels, which lie in close proximity to the diseased tissue, are meticulously identified and protected throughout.
The duration of the procedure ranges from 30 minutes to over an hour depending on the extent of the disease.
What is the recovery ?
The hand is dressed and rested for the first few days. Wound care is required over several weeks.
Physiotherapy is routinely prescribed to recover finger extension, strengthen the extensor muscles and soften the palmar scars.
Full recovery typically takes two to three months depending on the extent of the initial contracture.
What are the risks ?
Dupuytren's surgery is technically demanding due to the proximity of the digital nerves and vessels. Risks include:
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injury to a digital nerve, potentially causing numbness along one side of a finger
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vascular injury, rare but possible
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wound infection
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residual stiffness, particularly in longstanding contractures
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recurrence of the disease, possible in the long term, especially in younger patients