Dupuytren's contracture

Dupuytren's contracture is named after Baron Guillaume Dupuytren, who described the condition in 1831.

• There is a ligamentous membrane on the palm of the hand between the muscles of the thumb and little finger, which is referred to as the fascia palmaris.
• In this membrane, first ligamentous nodules (lumps) and later ligamentous bands are formed, which cause the fingers to bend and then cannot be extended (this is called finger contracture - hence Dupuyren's contracture).
• The cause of the disease is unknown, often observed to run in families, however the exact gene is not known.

Dupuytren's contracture is a benign disease, but it does not go away by itself and worsens over time.

A clear indication for surgery is the so-called table-test. That is, if you place your hand with the palm down and cannot touch the table with the palm, because the contracture of the fingers does not allow the hand to fully extend.

The assessment of Dupuytren's contracture is based on the sum of all flexion contractures of the affected finger joints (MCP + PIP + DIP).

• Grade 0
  • No finger contracture, only nodules or bands in the palm.
• Grade 1
  • Total sum of finger flexion contractures: 0–45°
• Grade 2
  • Total sum of finger flexion contractures: 45–90° 
• Grade 3
  • Total sum of finger flexion contractures: 90–135° 
• Grade 4
  • Total sum of finger flexion contractures: >135°

Depending on the extent of Dupuytren's contracture, the method of treatment is also chosen.

• Collagenase  - an enzyme that is injected into the contracture  and it breaks down the collagen (the matter forming the stripes on the palm). The disadvantage is that this disease tends to come back again after this treatment.
• Surgical treatment (fasciectomy) is a performed with a permanent removal of palmar fascia with excision of nodules and bands.

Depending on the degree of the disease, only part of the fascia (partial fasciectomy) or the entire fascia (radical fasciectomy) is removed.

• Sometimes it is necessary to perform the operation in several steps: in the first step the bands are just cut (fasciotomy) and fingers are stretched, subsequently (in the second step) entire fascia is completely removed.

Dupuytren's contracture surgery takes place under general anesthesia or when the entire upper limb is numb (brachial plexus anesthesia).

• On the palm, zig-zag incisions are used to open the skin and subcutaneous tissue and expose the palmar fascia along with the Dupuyten's contracture bands. Subsequently, it is resected.
• Smaller contractures can be operated on under local anesthesia.
• The procedure lasts 60-120 minutes, depending on the degree of the disease.

If the fingers have been contracted for too long, shortening of the ligaments and tendons occurs and a splint must be worn.

• The stitches remain for 2 weeks before they are removed.
• Sometimes a drainage (Redon's drain) is used to drain blood and secretions from the wound. The drainage is removed on 2nd day after the operation.
• The wound is covered with a bandage.
• As the tendons have not been treated, the hand can be used immediately.

Not every plastic surgeon is also involved in hand surgery, which includes the surtery treatment Dupuytren's contracture.

You can easily find a list of specialists and their specialization on Phivio.