Dupuytren's Contracture

Dupuytren’s Contracture affects the layer known as the fascia, which lies beneath the skin on the palm of the hand. The role of the fascia is to fasten the skin to deeper structures, enabling us to grip. 

The disease first makes its appearance as a small lump in the palm. Over time, this lump may form a cord of tissue that runs from the palm to the finger. After a while, this cord begins to shrink, drawing the finger into a clawed position. This is the contracture, and as it progresses the nuisance and disability associated with the condition worsens.

Often hereditary, the condition can take years to develop, but as a general rule, you should seek medical advice if you are unable to place the palm of your hand down flat on a tabletop. 

What surgery is available, and what techniques are involved?

Surgery is currently the only treatment available for Dupuytren’s Contracture. In mild cases, the contracture can be corrected by creating a zigzag scar, known as a z-plasty, across the surface of the palm and finger; through this scar the diseased tissue is removed and the joint is freed. The zigzag shape also prevents the scar from shrinking and affecting finger flexibility. Following surgery the wound is closed, although elements of the scar may be left open to allow the blood to drain away.

In more complex cases it can also be necessary to remove the overlying skin and replace it with a skin graft taken from either the inner part of the arm or from the groin.

What should I expect as a patient?

Patients are operated on using local or general anaesthetic, and surgery takes between 30 minutes to two hours. After surgery a dressing is applied and the hand should be rested for one week in a splint or cast. Most patients are able to drive again within 10 days of their operation.

As a patient, you will be seen by a surgeon, a nurse and a physiotherapist, and should be able to leave hospital on the same day as the operation. You will be seen again after a week or so to have your dressings changed, and then after two weeks to have your stitches removed. The surgery is usually effective, but sometimes does not bring about a completee correction. Possible complications include poor wound healing, incomplete correction, stiffness and recurrence of the contracture

The surgical treatment of Dupuytren’s Contracture is widely available on the NHS. 

Further Information

BSSH- the British Society for Surgery of the Hand
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