What is Dupuytren’s Disease?
Dupuytren’s disease is a genetic condition involving a fixed contracture of the hand which results in the inability to straighten the fingers, often the two smallest fingers. Tight bands develop in the palm and/or fingers which progressively cause the fingers to curl inwards. This can cause pain, and in severe cases skin hygiene problems.
How can surgery help?
Surgery involves removal on the bands of fibrous tissue in the palm and fingers, release of the affected joints, followed by lengthening of the skin with either skin flaps or skin grafts. This helps improve finger position and discomfort.
There is a non-surgical option now available, known as a collagenase injection. This involves an injection into the fibrous tissue which helps to dissolve the fibrous bands. It is done in 2 stages – the initial injection, and then manipulation of the fibrous bands and finger 1-2 days later which causes multiples fractures in the band. This option causes the bands to break in multiple sections, helping to release the contracture, however does not completely dissolve the fibrous tissue.
Who does this procedure suit?
Those who have diagnosed Dupuytren’s disease and the contracture is causing functional problems, pain, discomfort and concern with appearance.
What results will I expect?
It is likely you will achieve immediate improvement in your finger and hand position, as well as function. It is important to remain realistic in your outcome as Dupuytren’s disease may recur over time, however it could be years or even decades.
What’s the first step to take?
During your initial consultation your surgeon will determine the site of the contracture, discuss any symptoms you have such as pain and discomfort, expectations you have, questions about the procedure, medical history and current medication. We will provide as much information as possible so that you feel comfortable and informed.
How do I prepare for surgery?
Please ensure you have arranged someone to drive you home after your surgery and to help you out at home for a few days. To reduce risk of bleeding and bruising please make sure to:
- Avoid pain relievers and Vitamin E two weeks before surgery. Panadol, and vitamins B and C are safe to use.
- Inform your surgeon if you take any herbal medicines that may affect clotting and the anesthetic.
- Avoid smoking before and after surgery so as not to restrict circulation to the area and delay healing. Giving up is best.
- Inform us immediately if you’ve had any infection (cold or flu) the week before your surgery.
What happens on the day of my surgery?
We will guide you to prepare for surgery so that your procedure and recovery go smoothly.
- If your procedure is in the morning – do not eat or drink anything after midnight the night before.
- If your procedure is in the afternoon – do not eat or drink anything after 8.00am.
What should I expect during surgery?
Dupuytren’s disease surgery is performed under general anesthetic or an arm block where only your arm is anesthetized. The collagenase injection can be performed either under local anaesthetic or sedation. Whichever is used, you will be very comfortable and experience no pain during the surgery.
During the procedure, excision of the fibrous bands is made with great care as the nerves are located directly next to the bands. The joints of the fingers may also need releasing, as well as lengthening of any tight skin on the fingers by performing skin flaps or grafts. The incision is sutured and dressings applied. Simple procedures take approximately 30 minutes or up to 2 hours for a more complex operation, and you will likely be able to go home that day.
What should I expect after surgery?
- Your hand will be in a bulky bandage or plaster with a sling to wear at home. You may notice some bruising which will fade in 4-5 days.
- Local anesthetic is used at the end of the procedure so that you have pain relief for the following 6-8 hours.
- Some discomfort is normal for the first few days which is easily relieved with oral analgesics. Keeping the hand elevated in a sling for 2 days will also help settle the pain.
- A follow up appointment will be made 1 week after surgery to assess that the wound has healed well and to change the dressings. If necessary, we will refer you a see our hand therapist who will make a splint for you and guide you for the best recovery.
- After 2-4 weeks your hand can be used for light duties and return to heavier activities such as sports after 8 weeks. Your surgeon or hand therapist will guide you.
What are the risks and complications with this procedure?
As with any surgery there are some risks involved such as:
- Infection, excessive bleeding or bruising.
- Bleeding under the skin can occur and may require removal of stitches to wash out the area.
- Delayed wound healing.
- Finger numbness – usually temporary due to nerve bruising
- Residual joint contracture.
- Recurrence – due to the genetic predisposition of Dupuytren’s disease, the fibrous tissue can reform.
- Collagenase injections have the risk of skin bruising or breakdown, tendon rupture and possible chance of limited or no improvement.
Please call our office if you experience any of the following: excessive pain or bleeding, abnormal swelling or fever during the first 24 hours.