Dupuytren's Contracture

What is it?

Baron Guillaume Dupuytren was a famous French surgeon
who described this condition in the early part of the 19th
century, although it had been recorded long before that. The
condition most often starts with a firm knot of tissue, o r
nodule, in the palm. This may continue for months or years
or it may progress to the next stage of one or more fibrou s
cords extending into the fingers and pulling them into a bent
position. With some people the finger contracture develops
without anything forming in the palm first. The initial nodule
can be painful or uncomfortable when pressed but later there
is usually no pain. The contracture of the fingers may seriously
interfere with hand function. There is great variation in the
rate of progress but it is usually possible to distinguish the
more aggressive form of the condition fairly early on. The litlet
and ring fingers are most frequently affected. The contracture
develops mainly from palm to finger, sometimes across the
joints within the fingers and sometimes both, it which case i t
produces a more troublesome contracture. In severe cases i t
can affect other parts of the body, most often the feet which
involves an uncomfortable lump on the sole instead of toe
contracture.
The cause of Dupuytren’s contracture is not fully understood. It
runs in families and in some cases it appears after an injury
or operation, but it is not generally accepted that these are
direct causes of the condition. It may but that such incidents
determine the time of onset of a contracture that was going to
happen anyway.
It is important to understand that the abnormal tissue does
not involve the tendons that bend the fingers and that fingers
can function normally once the contracting bands are removed
as long as the joints are still mobile.

How is it treated?

Treatment of the early nodule phase (without contracture) has
not proved very helpful. Steroid injections into the nodule wlil
occasionally soften the lump. Similarly, the use of splintage
does not seem to delay or prevent the onset of contracture .
Once Dupuytren’s has developed to an extent that interferes
with function, surgical excision of the contracting cords is
generally felt to be the most appropriate treatment. Surgical
treatment is known as fasciectomy and can usually be done
under local anaesthetic as a day procedure. Incisions are
designed according to the position of the bands but usually
take a zigzag line to avoid straight scars which themselves
can contract later. The abnormal tissue is removed carefully
avoiding nerves, arteries, and tendons running into the fingers .
This is usually not a problem, but it can be difficult when the
condition has recurred. Damage to these nerves would resul t
in complete loss of feeling on one side of the finger tip bu t
slight patchy loss of feeling may occur temporarily without
significant nerve damage.
More recently an injection has been developed which may
help in some simple cases.
It should be noted that the condition can be controlled by
surgery or the injections, but there is no cure. It may recur.

Is Mr Callan experienced at this procedure?

Mr Callan has over 20 years experience at this procedure. He
performs Dupuytren’s resection regularly and keeps up to date
with the latest techniques. As a fully trained plastic surgeon,
Mr Callan performs this procedure to the highest standard
available.

Can I see photographs?

You can see photographs of people who have had this
procedure when you have your consultation. As Mr Callan
performs Dupuytren’s contracture release frequently, we have
a large number of photographs.

What are the results of surgery?

Usually very good. It is usualy possible to get the fingers
totally straight and fully functional. If it has been left untreated
with very bent fingers into the palm, or is multiply recurren t,
it is not always possible to restore full straightening to the
finger joints even when al abnormal tissue is removed
because ligaments holding the joints may have
tightened and ligament release may not be possible.
Sometimes heavy skin involvement, especialy after a recurrent
contracture, may mean that some skin has to be removed and
replaced with a skin graft.

What happens after surgery?

After surgery the hand is rested in a bandage. It is ver y
important to elevate the hand to minimise swelling. A
splint will probably need to be worn at night for up to six
months. Hand therapy may be started in the first two weeks
postoperatively. It is important to keep massaging and
extending the fingers for six months.
Most people regain movement without too much difficulty bu t
determination and persistence are needed. A small proportion
of people have difficulty with moving and can have a painfu l,
stiff hand for some weeks. A few people develop a painfu l
condition called reflex sympathetic dystrophy or chronic
regional pain syndrome, with sweating, stiffness and sensitiviyt
to cold. It is very rare.

And the future?

Dupuytren’s contracture is not a fully curable condition.
Eventually recurrence is likely in some form elsewhere in
the hand or in the same area but the correct approach is to
maintain function and mobility as far as possible, accepting
that further surgery may eventualy be necessary.

Will I need to be seen after surgery?

Yes. We will keep in close contact with you by telephone fo r
the first few days, then wil see you about ten days after
surgery, then at three weeks and at three months. You are of
course welcome to call or visit any time with any concerns