Dupuytren’s contracture is a localized development of scar tissue beneath the skin of the palm of the hand. The scarring accumulates in a tissue (fascia) that normally covers the tendons that pull the fingers to grip. It can cause lumps or dimples in the skin of the palm and can draw the fingers down into a bent position. As Dupuytren’s contracture progresses, more of the fascia becomes thickened and shortened. Dupuytren’s contracture initially may cause only a minor painless lump in the palm of the hand near the base of the finger(s).
Dupuytren’s contracture most commonly affects the ring (fourth) finger but can affect any and all fingers. This condition can also affect one or both hands. As the syndrome progresses, it can lead to an inability to fully extend the affected finger from the flexed position. This can result in a loss of normal grasping. Dupuytren’s contracture is not usually painful; the main problem however, is that you cannot use the affected fingers properly. The extent of the contracture varies greatly from mild to severe.
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Most cases occur in middle aged or older people but Dupuytren contracture can sometimes develop in younger adults. It is more common in men than women, and most commonly found in people of European descent.
The first clinical signs of Dupuytren’s contracture are usually small, painless nodules in the palm. The nodules may begin to combine and the skin becomes puckered. Eventually, in the later stages of the disease, the skin and underlying fascia contracts, causing an impairment of hand and finger function.
Make an appointment with your doctor if you experience hand pain, changes to the skin on your palms or any other signs and symptoms that concern you. Dupuytren’s contracture usually doesn’t cause pain and often doesn’t interfere with your ability to carry out everyday tasks.
Once you make an evaluation appointment, your doctor will conduct a physical exam to determine whether you have the syndrome or not. Your specialist may conduct an exam called a table top test. In this test, you place your hand palm-down on a table and gently press on the back of your hand. You’ll also be asked questions about your signs and symptoms. Your doctor will want to know whether you’re having difficulty using your hands; for example, if you able to extend your fingers to put on gloves or to shake someone’s hand.
This test is usually enough to determine if you suffer from Dupuytren’s contracture. However, your doctor may ask for other tests to rule out associated conditions, such as diabetes.
What type of surgery you undergo for Dupuytren’s contracture depends on factors such as your age, the degree of contracture in your fingers, as well as on the condition of the skin and bones of your hand. Depending on your case, the following surgeries exist:
Subcutaneous fasciotomy (release of cord tissue) – Subcutaneous fasciotomy is performed on patients who can’t undergo more extensive surgery or prefer to avoid the risks of an extensive surgery; i.e: older people and people in poor health. During this procedure, your surgeon severs the cords of tissue under the skin. It can be an open procedure, where your surgeon cuts open the skin with a scalpel. However, it can also be performed as an outpatient procedure using a needle to gain access to the cords of tissue.
Keep in mind, however, that Dupuytren’s contracture is likely to recur after subcutaneous fasciotomy. This type of surgery works best when Dupuytren’s contracture is limited to the palm of the hand.
Partial fasciectomy (partial removal of tissue) – Partial fasciectomy is the most common procedure performed to treat Dupuytren’s contracture. The skin on your hand is cut open to allow your surgeon to gain access to the connective tissue underneath. He will then cut the thickened connective tissue (fascia) so that you are able to straighten your fingers. After your specialist has cut the connective tissue, the skin is stitched back up. This surgery is often carried out under local anesthetic.
Complete fasciectomy (complete tissue removal) – Younger patients as well as those with the highest chance for recurrence might consider complete fasciectomy to completely remove the tissue on the palm of the hand. The diseased tissue in Dupuytren’s contracture usually attaches to the underside of the skin on your palm and fingers, so it may be necessary to remove the skin in order to completely remove the tissue. The removed skin can be replaced with skin grafts from another part of your body. Recurrence is rare after complete fasciectomy.
Your hand will be bandaged with a well-padded dressing and a splint for support after surgery. Physical or occupational therapy sessions may be needed after surgery for up to six weeks. Rehabilitation sessions may include heat treatments, soft tissue massage and vigorous stretching. Therapy treatments after surgery can make the difference when it comes to a successful result after surgery.
Whenever a Dupuytren’s contracture surgery is performed by a certified surgeon, it is always an incredibly safe procedure. However, you must keep in mind that, even though they are unusual, complications can happen and it is best to be informed concerning any possible risks.
Damage to either one of the nerves and/or one of the arteries of the involved finger is possible. If a nerve is injured, it can be repaired but a portion of the finger may become numb until the nerve has healed. If one of the arteries is injured, then repair is not always necessary because the other artery can provide sufficient blood flow to the finger. Skin loss over the area of the incision can also occur but is relatively unusual. If this were to happen a skin graft may be required.
Other risks concerning this surgery include deformity of the hand as well as loss of hand function due to contracture.
Make sure you strictly follow the instruction of your doctor during and after the procedure so that such scenarios are fully prevented.
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