Dupuytren's Contracture

Dupuytren's contracture is a thickening of deep tissue (fascia) which passes from the palm into the fingers. Shortening of this tissue causes "bands" which pull the fingers into the palm. The cause of this is unknown but it tends to run in families and may indicate that you had hepatitis! The condition is progressive (in batches) and the only treatment is surgery. If untreated, the fingers will be gradually pulled into the palm.

Surgery

Fasciectomy: Correction is usually done by removal of the fascia. The entire wound is stitched up in a zigzag manner which lengthens it but occasionally, sometimes a segment of the wound is not stitched, being left open to heal by itself (open-palm technique).

Your Dupuytren's contracture will be corrected by removal of the abnormal fascia and relaxation of the overlaying skin.

The operation is performed under regional anaesthesia.This area and possibly some of the fingers will remain numb for up to ten hours after surgery. As this effect wears off, it may be worth taking some pain killers. The operation can be perfomanced as a ambulatory procedere.

Post-operative care

Hand elevation is important to prevent swelling and stiffness of the fingers. Please remember not to walk with your hand dangling, or to sit with your hand held in your lap.A drainage will be placed for 24 houres ( sometimes less ).

You will be initially placed in a bulky dressing, consisting of gauze, wool, plaster and crepe bandage to rest the hand. The dressing will be removed after 24–72 hours and then be left open at this stage, if possible, to allow mobilisation of the fingers.

Usually the entire wound is stitched up in a zigzag manner but occasionally, a segment of the wound is not stitched, being left open to heal by itself (open-palm technique). This usually requires dressings to be applied to the palm for 2-3 weeks whilst mobilisation is performed in the usual way.

Your stitches will be removed about 12 days after the operation. Following this the scar will be somewhat firm to touch and tender. This can be helped by massaging the area firmly with the moisturizing cream.

You can usually drive a car after 1–2 weeks as long as you are comfortable and have regained good finger movements. Timing of your return to work is variable according to your occupation and you should discuss this.

Complications

Nerve damage

The nerves running to the fingers can be damaged during the surgery and cause numbness in part of the finger. This complication is unusual in unoperated areas but becomes more common during repeat operations. If this occurs the nerve would be repaired immediately if possible.

Recurrence

Dupuytren's contracture can return either at site of surgery or elsewhere in the hand. It is very rare under a skin-grafted area.

Infection

Can occur after any operation. This would be treated with antibiotics.

Scar

You will have a scar on the palm and finger (and in the groin if you have a skin-graft). This will be somewhat firm to touch and tender for 6–8 weeks. This can be helped by massaging the area firmly with the moisturizing cream.

Bleeding

Can cause a collection of blood under the stitches which is painful and which can cause problems with the wound. This is usually managed by removing some of the stitches but occasionally it is necessary to return to the operating theatre to stop bleeding. Tell the surgeon if you are on anticoagulants or aspirin.

Stiffness

About 5% (1 in 20) of people are sensitive to hand surgery and their hand may become swollen, painful and stiff after any operation (algodystrophy). This problem cannot be predicted but will be watched for afterwards and treated with physiotherapy.

Correction

It is often not possible to fully straighten fingers which are very bent at the time of operation, particularly if much of the bend occurs in the middle joint of the finger (PIPJoint especially the little finger ). This can sometimes be improved with splinting later after the operation.

Skin Loss

Portions of the zigzag scars and skin grafts can fail to "take" after the operation. This is unusual if you do not smoke and follow all the advice given.