Dupuytren's disease is the formation of lumpiness and scar-like thickening in the palm of the hand and fingers. As the disease progresses the thickening forms into cords that contract and gradually pull the fingers into the palm. If left untreated the fingers become progressively bent and cannot be straightened. This becomes an annoyance as the bent fingers get in the way and reduces hand function.
Treatment is aimed at releasing or removing the cords, allowing the fingers to straighten out. Ideally this should be done before the fingers become too bent. Once the proximal interphalangeal joint (middle knuckle of the finger) has been flexed for a prolonged period of time it can be very hard to fully straighten the finger even if all of the Dupuytren's disease has been removed.
Treatment is recommended if the hand can no longer be placed flat on the table top.
Surgery is usually performed as a daycase procedure under general anaesthetic. The thick cords of Dupuytren's disease are removed via an incision on the palm of the hand extending into the affected fingers. The skin is then lengthened using a technique called z-plasty. This leaves a zig-zag scar running along the palm and finger. In some circumstances it may be advised to use a skin graft to replace the diseased skin in the palm / base of finger. The wounds are all closed using dissolving sutures and the fingers are held straight in a splint. The hand should be kept elevated and the bandages kept dry for a week. At the one week visit the bandage will be replaced with a stick-on dressing and the hand can then be washed. You will be referred to a hand therapist for ongoing exercises and be fitted with a splint to wear at night only. This prevents the fingers going back to the old flexed position. It usually takes about 4-6 weeks for the hand to heal enough for you to be able to return to moderate strength activities.
Side effects and complications
There will be a permanent zig-zag scar that runs along the finger and palm of the hand. This usually fades over 12 months to become a faint white line. Regular massage and moisturising of the scar will help encourage it to soften.
It is possible that the nerves supplying sensation to the finger tips may become bruised or cut during the surgery. The Dupuytren's disease often wraps around these sensory nerves and must be carefully dissected free. Damage to these nerves results in numbness at the finger tip.
Release or removal of the Dupuytren's cords does not treat the underlying disease. The thickening in the palm will continue to develop, albeit usually slowly. Other fingers may become affected and sometimes the same digit may need to be released again.
2-3% of patients may develop pain and stiffness in the hand know as chronic regional pain syndrome (CRPS), following any type of hand surgery.
