Dupuytren’s Contracture

Dupuytren’s Disease causes an excessive production of abnormal collagen, which leads to a thickening of the fibrous tissue layer under the skin of the palms, fingers and hands.

The disease often proceeds to cause contractures in the small joints of the fingers, leading to a loss of movement in the finger. It commonly occurs in the ring finger and little finger, and occasionally the middle finger. The thumb and index finger can also be affected.

If the condition is not affecting the mobility of the hand, treatment can be delayed. If you are experiencing pain or having difficulty using your hands then early intervention is important to prevent irreversible joint contracture.

What can I expect in the consultation process?

In the initial consultation Dr Arianayagam will carefully and thoroughly inspect your hands to assess the severity of the condition. Note that Dupuytren’s Contracture is diagnosed based on your history and physical presentation. There is no special testing required.

Once he has completed his assessment, the doctor will recommend treatment. More conservative treatments such as heat, massage and exercise may be recommended before moving to surgery. If the condition is severe, the doctor may recommend moving straight to surgery.

What does the surgery involve?

The surgery is usually performed on an outpatient basis under general anaesthesia and the thickened fibrous tissue is removed. The surgery is very complicated due to the tissues wrapping themselves around the digital nerves. High magnification loupes (surgical telescopes) are used to ensure surgical precision and the surgery is done with the hands freed of blood with the use of a tourniquet.

If the skin is affected then some relief may be gained by extending the skin using Z-shaped incisions.   Alternatively a full thickness skin graft may be necessary.

What is recovery like?

In the first week after surgery your hand will be stabilised with a splint. After one week this is replaced by a compression bandage to prevent any further swelling. Most patients will need to wear the bandage for a period of 3-4 weeks.

You will be able to go back to work after 6 weeks. Avoid extreme stress to the hand from activities such as tennis or golf for 10-12 weeks.

Will I have scars?

Any surgery will leave scars. In most cases the scar tissue becomes difficult to see after a period of 12 to 18 months. You hands are very sensitive, so you should expect the scars to look bulging and red in the first weeks and months, but with proper care this will settle. We will provide extensive scar management advice post surgery.

What complications can arise from this procedure?

As with all surgical procedures, there will always be risks such as post-operative bleeding, allergic reactions, infection, deep vein thrombosis and haemotoma.

There are also some risks and complications that are specific to hand surgery.

Injury to the arteries of the fingers or hand.

Nerve damage causing weakness, paralysis or loss of feeling in the hand area.

Recurrence of the contracture.

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