Consultant – Gavin Brigstocke

What is Dupuytren’s Disease?
Dupuytren’s disease is a progressive thickening of the deep tissue of the palm and fingers. Small benign nodules grow in the palm of the hand which over time may progress to thickened cords extending into the digits forcing the fingers to contract.

Dupuytren’s disease is not a serious condition, and most cases are painless. Treatment is not always necessary but if the contracture affects the hand’s function the contracture may be surgically released. The severity of the condition will determine the type of procedure required. Even after treatment, Dupuytren’s can recur in which case more extensive surgery may be required.

What treatments are available?
There is no cure for Dupuytren’s disease. Surgery can correct contractures of the digits but cannot eradicate the disease.

Non-operative treatments are available in the out-patient department and often very successful. The cord may be released by needling through the skin or alternatively by the injection of enzymes. Once disrupted the cord is snapped with a manipulation procedure. These treatments are suitable for some patients with disease limited to the palm.

Surgical options include segmental fasciectomy when a short segment of the cord is removed, regional fasciectomy when the entire cord is removed and dermofasciectomy when the cord and overlying skin is removed and replaced by a skin graft from the upper arm. Following surgery the hand is fitted with a splint and hand therapy is essential in recovering movement and function of the hand.

What are the outcomes?
The final outcome of surgery is dependent upon the extent and behaviour of the disease and the type of surgery required. The vast majority of patients are very happy with the result of their surgery, however complications can occur. Recurrence over a lifetime is almost inevitable. Incomplete correction of finger contractures may occur particularly with longstanding severe deformities. Infections as well as injuries to the blood vessels and nerves may occur.

Further information:
https://www.bssh.ac.uk/patients/conditions/25/dupuytrens_disease