Dupuytrens Contracture

The Condition

Your finger contracture is due to a condition called Dupuytren’s disease. You have “scar” tissue, which forms in the hand and finger without an injury. The “scar tissue” does not stretch like ordinary tissue and gradually pulls the finger down towards the palm.

The cause of Dupuytren’s disease is usually unknown but it often “runs in families” and other members of your family may have had this condition.

The correct timing for surgery is when you are unable to put your hand flat on a table.

The tendons cannot straighten your finger fully because of the tight “scar tissue” that forms in the hand and it is only this “scar tissue” that we remove during the operation. 
 

Injection Treatment

Many Dupuytren’s contractures are suitable for an injection of Xiapex, which effectively dissolves the band of Dupuytren’s tissue.  Dupuytren’s tissue that is just within the finger may not be suitable for injection and for very severe contractures in general, injection treatment may not be suitable.  The injection is given one day as an outpatient and the following day the finger is manipulated and straightened, the injection having effectively dissolved the band. 

The arm may be swollen and painful for a few days after the injection.  Mr Samuel has received certification to allow him to use this drug.

The Operation

Surgery is more comfortable when carried out under a general anaesthetic and in complex cases where surgery takes a long time it is important for the hand to be kept very still. General anaesthetic is invariably used.

The disease does not affect the tendons or nerves. Surgery removes the “scar tissue” whilst protecting the tendons, nerves and arteries. With modern surgical techniques and surgery carried out at an early stage, we can usually get a full correction of the deformity. Parts of the wound may be deliberately not stitched and left open, to heal themselves. This is to prevent tightness of the skin pulling the finger back again. Surgery is usually done as a “day case” so you will not need to stay in hospital, but occasionally surgery means that you are in hospital for one night.

After the Operation

A large bandage is applied to the hand. You need to keep your hand raised so your hand is at head height for 24 – 48 hours after surgery. This helps to prevent swelling of the hand and reduces pain. You can use your hand as freely as the bandage permits.

During the operation when you are asleep, local anaesthetic is put into the hand so that when you wake up the hand is numb and not painful. The numb feeling from the local anaesthetic lasts for 6 – 9 hours. The hand will be “achey” rather than painful after this.

You will be seen 10 days after the operation in the clinic. Any stitches we use are removed 10 days after surgery. Usually a bandage is not needed after that time. If, however, the wound has not been fully stitched, a small dressing will be put on at this stage.

You should be able to drive by 2 – 3 weeks after surgery. Exercising the fingers in warm/hot water after the dressings are removed is encouraged. You will not be restricted in any way, the more you use the hand the better. Using E45 cream is a useful way of managing the area and keeps the skin soft and supple. This can start after all the dressings are removed. You should be able to return to office type work by 2 – 3 weeks after surgery following “routine” surgery. If you do heavy manual work you will need to be off work for 4 – 5 weeks after surgery.

Risks of Surgery

1. Dupuytren’s tissue can recur but this rarely results in a significant problem. The rate of recurrence is about 5% of all operations, often as a small swelling but this usually does not cause the finger to be pulled down into the palm.
2. Post-operative complications such as infection are very rare, well under 5% of all operations, this is usually easily managed with antibiotics.
3. Circulation disturbance (sympathetic dystrophy or regional pain syndrome) can occur in approx 1% of all operations. Prompt treatment with medication or injection is usually very effective. You will be reviewed regularly after surgery so this or any other complication, is treated promptly.
4. Numbness of a part of a finger may occur if one of the two nerves that go to each finger is stretched or damaged during surgery. This occurs in 1% of all operations.

References

Green – Textbook of Hand Surgery
Bulstrode – Textbook of Orthopaedic Surgery
Internet sites: www.mayoclinic.com     www.orthogate.com