What is Dupuytren’s contracture disease?

Dupuytren’s contracture is a genetic disease, which affects the fascia (layer of tissue that lies under the skin) of the hands and fingers. The aponeurosis is a layer of tissue between the skin and fat of the palm of the hand. In Dupuytren’s contracture, this fascia becomes inflamed and produces nodules (lumps) and cords of tissue. As these cords tighten, one or more fingers might be pulled toward the palm, thus preventing the extension of the finger(s).

When the flexion of a finger is significant, it may warrant corrective surgery called a palmar aponevrectomy.

What are the symptoms of Dupuytren’s contracture disease?

The most commonly observed symptoms of Dupuytren’s contracture are lumps or nodules in the palm, difficulty in straightening the finger, and contracture of the nodules which forms tough bands under the skin.

The cause of Dupuytren’s contracture is unknown. However, there are certain risk factors that may increase your chance of developing the condition. These can include the following:

  • Age: It occurs more frequently around ages 40.
  • Social Habits: Smoking and drinking alcohol may increase your risk of developing the condition
  • Medical Conditions: Patients with diabetes, alcoholism, cirrhosis of the liver, and seizure disorders appear to be at increased risk of developing the condition.
  • Gender: The condition is more common in males than females.
  • Heredity: The condition tends to run in families.
  • Ancestry: Most commonly affected are northern Europeans and people of Scandinavian descent.

What are the procedure techniques and scars

An incision is made along the band in the finger. Dr Boudana uses the incision to divide and remove the thickened connective tissue, allowing the finger to straighten, the scar will be made as a zigzag to prevent the scar tightening.

Following the procedure, a light compression dressing is applied and will be removed on the second day after surgery to be replaced by a light wound dressing.

  • Anaesthesia:
    Local (without tourniquet)
  • Duration:
    1 hour
  • Pain level:
    4/10
  • Recovery time:
    2 to 6 weeks
  • Resumption of physical activities:
    6 weeks

Procedure details

Dupuytren’s contracture is diagnosed based on the patient’s history and physical examination without any special tests required.

The physical examination may involve pressing on different parts of your hands and fingers to assess for hardened knots or tough bands of tissue.

Sometimes, because of considerable contracture, a skin graft must be performed to allow the fingers to be extended. This will be discussed during the pre-operative consultation with Dr. Boudana.

Aponevrectomy consists of removing only the part of the palmar aponeurosis that causes the formation of nodules or tightened cords. It is impossible to remove the entire aponeurosis.

After disinfection of the hand, local anaesthesia is performed on the palm area to be treated.

Then the removal of the nodules and cords is carried out. Particular attention must be paid to the preservation of the fingers’ blood vessels and nerves, whose diameters are in the order of millimetres. Sometimes, because of considerable contracture, a skin graft must be performed to allow the fingers to be extended. This should be discussed during the pre-operative consultation with Dr. Boudana.

After the surgery, you will receive a personalized follow-up. Our nurses will also be available and will perform all dressing changes at our clinic.

You will be given a postoperative instruction sheet when you are discharged as well as a prescription for pain medication.

Results

Considerable work with the hand therapists is necessary to get the optimum results. Visits with the hand therapist will initially be weekly, then after 6-8 weeks will usually be second weekly. The biggest hurdle after surgery is regaining full flexion of the fingers, and a lot of work is required to achieve this.

It is important to understand that recurrences are frequent because it is a genetic disease. The aim of surgery is to treat lesions related to the current progression of the disease, but surgery does not cure Dupuytren’s contracture. It can remain active after the operation causing other similar lesions in the treated area and even more so in the non-operated areas.

Ready for get rid of your hand pain?

Schedule your personal or virtual consultation with Dr. David Boudana.

During your consultation, Dr. Boudana will take the time to address your specific goals and to discuss your treatment options. He will determine if the Dupuytren’s contracture surgery is right for you and review the results that can be realistically achieved.