What is Dupuytren's contracture?
The so-called Dupuytren's contracture is caused by the thickening and shrinking of the hand connective tissue, which results in a hand deformation characterized by tangible fibrous lumps or cords. This initially painless condition gradually pulls one or more fingers towards the palm, thus simultaneously impairing the fingers' gripping ability.
Dupuytren's contracture is a condition that develops relatively very slowly, perhaps over several years. It begins with the formation of a painless lump whose centre and area gradually extend to one or more fingers, thus impairing their movement and preventing their straightening.
There are three types of Dupuytren's contracture depending on the extent:
- Simple contracture that affects one, usually the fourth or fifth finger.
- Complicated contracture that affects the entire hand including the thumb.
- Palm-type contracture that affects only the palm.
Who can have surgery for Dupuytren's contracture?
Dupuytren's contracture cannot be directly prevented because the primary causes of its emergence are unknown. It is usually treated by a surgery, usually when the patients already suffer from limited ability to use their fingers; yet, this condition can already be treated at the time of its emergence. The patients, however, frequently ignore the painless symptoms and pointlessly postpone the visit to a doctor despite the fact that the surgery is far easier in the early stages.
Subsequently, Dupuytren's contracture is then treated in advanced stages when complete recovery of the fingers' functionality may no longer be possible. It is therefore essential that a qualified specialist should diagnose the contracture, define its extent and propose a suitable surgery, which we are able to provide at our clinic.
Before the surgery
Dupuytren's contracture is operated under local anaesthesia. The patient is not required to undergo any special preparation except the standard preoperative consultations.
Nonetheless, as in any surgeries, the doctor must be informed of the patient's health issues, medications and allergies. If the patient takes anti-inflammatory or blood-thinning drugs, he should discontinue them or at least reduce their doses before the surgery, following a consultation with the doctor.
Course of the surgery
The Dupuytren's contracture surgery is carried out in the so-called bloodless environment to ensure that blood does not interfere with the operation. The blood supply to the palm is therefore stopped by a tourniquet before the surgery.
The operation can be carried out in several ways depending on the extent of the condition. The easiest solution is cutting the problematic ligament cord by means of aponeurotomy with the use of a needle, which does not leave any scar. However, this treatment poses the risk of regression.
The specialists therefore recommend removing the problematic tissue. This treatment is referred to as aponeurectomy. The doctor must decide whether to remove only the damaged tissue or also the surrounding tissue in order to prevent recurrence of the condition. The amount of removed tissue is determined by the necessity to preserve nerves, blood vessels and tendons in the palm. Sometimes some of the skin must also be removed together with the internal tissue because it is connected with the subcutaneous tissue. In these cases, the skin must be transplanted.
After the surgery
Dupuytren's contracture is one-day surgery, so that the patient can go home on the same day or the day following the operation. The doctor informs the patient of postoperative wound treatment, recovery and rehabilitation during medical checks.
The surgery wound must be kept in a sterile environment until the stitches are removed, which is usually two weeks after the surgery. The bandage must not be too tight to inhibit movement during rehabilitation.
Shortly after the surgery, the patient may feel pain and the operation area may swell up. To ease this condition, we recommend lifting the arm and/or taking painkillers. The postoperative care also includes fixing the palm at night to keep the fingers stretched for the period of 3 - 6 months.
The doctors recommend starting a rehabilitation as soon as possible even if the patient feels a pain during the exercises. The postoperative wound may slightly bleed, but early rehabilitation is very important for elimination of scarred tissue in the palm. This situation could have an effect similar to the actual illness, i.e. reducing the moveability of the palm. The recovery lasts one to three months, depending on the seriousness of the condition before the surgery. The patient's approach to the condition and the wound healing speed also play an important role.
Complications
The Dupuytren's contracture surgery is challenging due to the large amount of blood vessels and nerve endings in the palm where much of the tissue must often be removed. An injury to the structures in the wound area may cause temporary or permanent numbness or tingling.
Frequently asked questions
What is Dupuytren's contracture?
- Dupuytren's contracture is a condition in which the palmar connective tissue thickens, thus causing the bending of one or more fingers towards the palm, restricting their moveability.
What are the symptoms of Dupuytren's contracture?
- First, a painless lump develops in the palm and gradually extends. Over time, the fingers bend towards the palm and lose their mobility, thus impairing the grip and hampering everyday activities.
How is Dupuytren's contracture treated?
- The treatment usually involves a surgery, which loosens or removes the affected tissue in order to restore moveability of the fingers. The operation is carried out under local anaesthesia.
How long does postoperative recovery take?
- The recovery usually lasts 1 - 3 months depending on the extent of the surgery and wound healing speed. Rehabilitation, an important part of the recovery, helps restore full function of the hand.
Can Dupuytren's contracture return after the surgery?
- Yes, the condition may return in certain cases, mainly if an insufficient amount of tissue has been removed. You should therefore follow the doctor's recommendations and attend regular medical checks.
