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Dupuytren’s Contracture is a medical condition that can appear in the fingers and palm of the hand, and it causes them to become tight and the fingers to bend. This health issues is also known as Contracted Fingers. It is considered that it has its origins back to the Vikings. It is a hereditary disease, because it runs in families. Sometimes it is triggered by an operation or small injury, but it can also occur occasionally.
The Dupuytrens surgery is quite helpful for the people who cannot fully straighten one or more fingers because of thickening and tightness in the palm or fingers of the hand. If people experience contracted fingers they find difficult to perform the simple daily tasks. They have difficulties in putting their hands into their pockets, or they even pock themselves in the eye when they wash their face. In case the tightness is pronounced or longstanding, the condition may be difficult to be successfully treated, so it is advisable people to have a medical consultation as soon as they see that they are not able to place their hand flat because of contracted fingers. According to the severity of the condition, the patient can benefit of one of the options available.
If the patients notice that they cannot place their hand flat on the table, then they should make an appointment with a specialist. Depending on the severity of their condition, they would have access to different treatment options. The specialist will consider the circumstances of the patient when they would decide the treatment.
When the patient meets their surgeon, they should ask them any questions they have related to the procedure. Also, they will discuss on the what will happen before and after the operation, and how they will deal with the pain. It is important to inform the patient about the process to put their mind to rest.
During the Dupuytrens surgery, the patient will be injected with local anaesthetic, because it is a day case. The patient remains awake during the surgery, because this is the gold-procedure to minimise the chances of recurrence. The surgery will remove the abnormal thickened tissues and for the following weeks, they will have to change dressings for the wound. In addition, the following months it will be required hand therapy. According to certain factors, as the tissues involved, the severity of the angle of contracture and the period of time the digit has been bent, the level of correction will differ.
The surgeon can use different techniques. A simple procedure would involve taking away the diseased fascia under the skin of the patient, but in case of a complex procedure, the skin would be also removed and the surgeon would place a skin graft to cover the diseased area. The surgeon would decide upon the suitable option.
As any other intervention, this one presents a risk of complications as bleeding, pain, scarring and infection of the surgical wound. Specific risks with this procedure are:
- Stiffness of the finger joints
- Wound healing issues
- Injuries to the small arteries of the fingers
- Incomplete correction of the contracture
- Pain syndrome that can lead to loss of the use of the hand
When having this procedure, the patient should be able to leave the Centre for Surgery the same day, but according to the specific conditions of the disease, the doctor can recommend them a one-night stay.
The patient will have to do specific exercises, and post-operative hand therapy to minimise the scar tissue and to make a good recovery. It is important to follow the doctor’s recommendations, because the healing scar tissue can cause fingers to contract in the future. Even if the patient has the injection treatment or the surgery, they will still suffer from the Dupuytren’s disease, and this means that they might experience contractures again.
In the beginning, the surgeon may recommend to wear a hand splint, especially during nighttime. After the surgery, it may take some time for the hand to settle down, especially if the patient has a fasciotomy. Also, at the beginning the scars may be quite thick.
Are there alternatives for Dupuytren’s Contracture?
There are alternative treatments that interrupt the affected tissue without removing it. They include using a special needle to loose the tight tissue or using an enzyme to dissolve sections of the tissue. These techniques can strengthen the fingers, but they will would remove the tight dupuytren’s tissue. This means that there are greater chances of a recurrent episode and the fingers will not be fully corrected.
When should I see a doctor?
It is advisable to seek for help as soon as you cannot place your flat hand on the table, because the more you wait, the more difficult would be for the doctor to treat the conditions successfully. When you notice that your contracted fingers do not allow you make simple functions, you should see a doctor, and see if you suffer from this condition. You should make an appointment if you are not able to properly wash your face due to contracted fingers.
Am I a good candidate for Dupuytrens surgery?
You can have this surgery if you are not able to straighten one or more of the fingers from your hands. Also, you can try this procedure if you had the alternative treatments and you are not satisfied with the results. The alternative treatments are appealing to patients, but if you tried them, and your fingers are not fully corrected, or the contracture reappeared, then you should consider having a surgery.
Do I still have the Dupuytren’s disease after I get the surgery?
The surgery will remove the diseased tissue, but you will still suffer from this condition. This means that there are chances in the future the contracture to appear again, and you should have regularly checks on the state of your hands.