What is Dupuytren's Disease

Dupuytren’s contracture (also called Dupuytren’s disease) is an abnormal thickening of the skin in the palm of your hand at the base of your fingers. This thickened area may develop into a hard lump or thick band.

The treatment of Dupuytren's disease

Most people with Dupuytren’s Disease do not need any treatment. The disease is usually quite mild, with limited flexion deformities of the digits. Splinting and physiotherapy will be of no benefit to patients with this problem. Massage treatment and attempts to manipulate the digits into more extension has not ever been successful. If the contracture becomes significant enough to interfere with function, formal intervention will be required.

Intervention for Dupuytren’s Disease can be divided into three categories:

Firstly, a traditional operation which involves excision of the abnormal tissue can be performed and is usually very successful in obtaining greater extension of the affected digits. This surgical procedure for DUPUYTREN’S DISEASE is called a palmar fasciectomy. The skin is usually closed with sutures that are removed within two weeks of intervention. Occasional splinting may be required after surgery for more significant contractures, especially those that involve the PIP joints.

Secondly, a less invasive form of surgery is called a percutaneous aponeurotomy. This surgery is be performed with multiple stab wounds along the course of the abnormal fascia, releasing it sequentially in order to regain extension of the finger. This minimally invasive procedure has the benefit of a very fast recovery but, unfortunately, it does have a much higher recurrence rate.

Lastly, a series of injections can be performed into the abnormal tissue, with a solution called collagenase. This product will literally dissolve the cords within the hand and this usually followed by a manipulation of the digits 24 to 72 hours after injection in order to tear the cords that have been pre-dissolved by the collagenase.

All forms of treatment for Dupuytren’s Disease have their advantages and disadvantages. Patients are encouraged to discuss these issues with their surgeon.

Collagenase is currently not available in Canada, although it had been available for several years prior to July 2020.

Presenter: Dr. Bertrand Perey, Orthopaedic Surgeon, New Westminster, BC

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