Hand Surgery

Dupuytren’s Contracture

Dupuytren’s Disease is a benign condition of the hand, where a scar like thickening commencing in the palm eventually extends in to the fingers and leads to curled up fingers and restricted motion. Though the condition is not painful, it may progress until the fingers become deformed or completely disabled. Dupuytren’s has a genetic basis and is common amongst people whose ancestors come from the northern British Isles, northern Europe and Scandinavia (it’s also known as the Viking disease).

Usually diagnosed after age 50, it affects mainly men of Northern European and British Isles background. Often, but not always, a family history of the condition can be established. Usually the natural history of the disease is a slow progression from a palmar nodule to a linear cord with severe finger contractures over a 5-10 year period, however in some cases the development may be more rapid. The condition may affect other body areas such as the sole of the foot (plantar fasciitis), knuckle pads of fingers and the penis (Peyronie’s Disease). Dupuytren’s can also be associated with diabetes, epilepsy, alcoholism, and chronic lung disease, but the reasons are unknown.

Dr. Hamilton has worked in Scandinavia dealing with this condition, and is very experienced in its treatment. He will remove the offending cords of tissue, and lengthen the skin with plastic surgery techniques, sometimes using flaps or skin grafts. In most cases the surgery is very successful if the contracture is not too far advanced.

Treatment – Alternate Therapies

Although most hand surgeons believe that surgery is the most effective and definitive treatment for Dupuytren’s Disease, in recent times other currently unsubstantiated treatment forms have been offered, particularly for less severe disease. Recently attempts at treating the disease with ‘collagenase’ injections (to enzymatically break down the collagen in the Dupuytren’s bands) are being trialed. Although these injections have shown some initial promise in delaying surgery, early experience indicates they may not be effective as a reliable treatment. The other alternative treatment is needle fasciotomy, used to release the contracture bands without surgical incisions – but has a very high incidence of recurrence, usually requiring surgery in the future. Most recently surgical treatment of Dupuytren’s has been complemented with fat transfer to the hand in the hope that stem cells in fat will decrease the recurrence risk.

Treatment – Hand Surgery

The only effective and definitive treatment for a contracture of the fingers due to Dupuytren’s Disease is hand surgery. Because important digital nerves may become intertwined with Dupuytren’s bands in the palm and fingers, surgical procedures to correct contractures are best undertaken by a reconstructive plastic surgeon, with experience in skin flaps, skin grafts and microsurgery.

Dr Richard Hamilton will undertake a full assessment of your hand and digital contractures and discuss the appropriate technique to achieve the most functional outcome. The goal of hand surgery is to increase the motion of affected fingers by removing the thickened Dupuytren’s tissue bands and releasing the skin to allow normal movement once again. The procedure is usually undertaken as a day surgery case under a local nerve block, or occasionally general anaesthesia. Incisions are made longitudinally in the palm along the affected fingers and skin flaps are elevated exposing the underlying structures. With special care not to damage important structures (nerves, blood vessels and tendons), the Dupuytren’s collagen bands are carefully dissected and removed, and then the skin and joints are both released to allow normal digital motion. The palmar wounds are then closed using local skin flaps (Z plasties) and skin grafts, to minimise the possibility of recurrent contracture.

After surgery, patients can expect to see a significant improvement in their finger position and mobility. The usual postoperative course would involve 1 or 2 weeks in a protective dressing until the wounds have healed. Hand therapy is sometime implemented. To determine if you would benefit from surgery for Dupuytren’s disease, schedule a hand surgery consultation with our specialist hand and plastic surgeon Dr. Hamilton. Contact our Adelaide plastic surgery practice today to make the arrangements.