Dupuytren's Disease
Dupuytren's Disease - The Thick Cord
Dupuytren's Disease - Collagenase Injection
24 Hours Later - Cord Dissolved, and finger straight.
Key Points: Dupuytren's Surgery
Type of Anaesthetic: Local/General Length of Procedure: 2-2.5 hours Nights in Hospital: 0-1 nights Recovery: Time off Work: around 2 weeks Back to Normal: around 4 weeks |
Dupuytren's contracture is a hand deformity that usually develops slowly, over years. Dupuytren's contracture affects a layer of tissue that lies under the skin of your palm. Knots of tissue form under the skin — eventually forming a thick cord that can pull one or more of your fingers into a bent position.
Once this occurs, the fingers affected by Dupuytren's contracture can't be straightened completely, which can complicate everyday activities such as placing your hands in your pockets, putting on gloves or shaking hands. Dupuytren's contracture most commonly affects the ring finger and little finger, and occurs most often in older men of Northern European descent. A number of treatments are available to slow the progression of Dupuytren's contracture and relieve symptoms. How do I get Dupuytren’s disease? A number of factors are believed to increase your risk of the disease, including: Age: Dupuytren's contracture occurs most commonly after the age of 50. Your sex: Men are more likely to develop Dupuytren's and to have more severe contractures than are women. Ancestry: People of Northern European descent are at higher risk of the disease. Family history: Dupuytren's contracture often runs in families. Tobacco and alcohol use: Smoking is associated with an increased risk of Dupuytren's contracture, perhaps because of microscopic changes within blood vessels caused by smoking. Alcohol intake also is associated with Dupuytren's. Diabetes: People with diabetes are reported to have an increased risk of Dupuytren's contracture. Treatment If the disease progresses slowly, causes no pain and has little impact on your ability to use your hands for everyday tasks, you may not need treatment. Instead, you may choose to wait and see if Dupuytren's contracture progresses. Treatment involves removing or breaking apart the cords that are pulling your fingers in toward your palm. This can be done in several different ways. The choice of procedure depends on the severity of your symptoms and any other health problems you may have. Needling: This technique uses a needle, inserted through your skin, to puncture and "break" the cord of tissue that's contracting a finger. Contractures often recur but the procedure can be repeated. The main advantages of the needling technique are that there is no incision, it can be done on several fingers at the same time, and usually very little physical therapy is needed afterward. The main disadvantage is that it cannot be used in some locations in the finger, because it could damage a nerve or tendon. Enzyme injections: Injecting a type of enzyme into the taut cord in your palm can soften and weaken it — allowing your doctor to later manipulate your hand in an attempt to break the cord and straighten your fingers. The advantages and disadvantages of the enzyme injection are similar to needling, except that the enzyme injection may be more painful initially. Surgery: Another option is to surgically remove the tissue in your palm affected by the disease (Fasciectomy). This may be challenging because it's difficult to identify tissue in very early stages of the disease. Diseased tissue may also attach to the skin, making it difficult to remove and increasing the chances of recurrence. The main advantage to surgery is that it results in a more complete joint release than that provided by the needle or enzyme methods. The main disadvantages are that physical therapy is usually needed after surgery, and the recovery time can be longer. In some severe cases, surgeons remove all the tissue likely to be affected by Dupuytren's contracture, including the attached skin. In these cases a skin graft will be needed to cover the open wound. This surgery is the most invasive option and has the longest recovery time. People usually require months of intensive physical therapy afterward. Incisions The incisions are usually along the palm and into the involved finger. Scars These scars tend to heal very well but are prone to some stretching over time. They will initially appear a little pink in the first few weeks, but will then fade to white. Most patients will form extremely good quality scars over time. The length of time will vary in each individual patient. However it is important to start massaging early in order to avoid thickened scar unless you’ve had skin excision in which case massage therapy starts later. Medicines A full medical history will be obtained before any surgery. As a precaution, do not take any over the counter medicines or herbal remedies prior to surgery or for 3 days following. Also avoid aspirin, ibuprofen and Voltarol based tablets. It would be useful to bring a list of any prescribed medications to your Pre-operative assessment. Smoking If you are a smoker, try and stop for 6 weeks before and after surgery as it can reduce the chances of complications. Recovering from Dupuytren’s Fasciectomy Length Of Surgery : The Operation takes 2 hours - 2.5 hours depending on the areas to be treated. This can be done under local anaesthetic though it is usually by general anaesthetic. Length Of Stay In Hospital : Usually a day case operation which means you’ll be home the same day. Dressings And Stitches: Your hand will be in a splint to keep your fingers straight and to reduce pain after the operation. This splint is usually worn for 5 days and the dressings are changed and a night splint applied. The sutures are usually removed after about 14 days by which time all wounds are usually healed. Hand therapy exercises are then initiated. You will need to wear the night splint for about 3 months. Post-Operative Instructions And Recovery Day 1: You should be taking it very easy! Relaxing with your hand elevated at home and on a few pillows when asleep. Day 2-5: You can be up and about but you may be in some discomfort so avoid using your hand Day 5-14: Most of the swelling and bruising will settle over this next week. You will be feeling much better from here onwards. You can start hand exercises gently and build it up over the next 10 days. Week 4 onwards: You will be nearly back to normal. Time Off Work And Socialising : People vary in recovery and this will depend on the size of area treated, but allow 10-14 days. Full anaesthetic can take longer to recover from. Most patients are very comfortable at one week and feel more stiff than in pain. Time To Exercise: Patients usually feel able to exercise the fingers gently after 14 days. Strenuous exercise (aerobics etc) should be avoided for 3 weeks, and contact sports for 6 weeks. Driving Patients should avoid driving until they are completely free of pain and restriction, and be able to confidently perform an emergency stop. This is to ensure they will be covered by their insurance policy. It may take up to two or three weeks to recover sufficiently. Follow Up We will check your wound at day 5 and again the following week. You will then have an appointment with Amir Tadros at 3 months. Final Outcome Although most of your result will be noticeable immediately it will continue to improve over the first three months. Potential Complications With Dupuytren’s Fasciectomy This is a routine operation that is a great success for the vast majority of patients. However, as with any procedure, it is very important you understand what can go wrong as well as right. The potential complications are listed below: Wound healing problems: Occasionally, the wounds don’t heal within 14 days and the dressings may continue for a longer period depending on the wound. Scars: The quality of scars vary between patients as they may stretch differently. Skin irregularity: Small areas of irregularity and skin thickening can be observed. Softening of the scar: The tightening will soften over the first 6 months with the scar falling slightly. Altered sensation: Some altered sensation can be noticed but usually settles over the first few weeks. Bruising/bleeding: Usually minor but can be greater occasionally. General operation risks: Chest infections, Blood clots in the leg or lung (DVT or PE). Although rare it is important to avoid these by not smoking, being excessively overweight and moving about after surgery as soon as possible. |
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