Surgical Hospital :: Orthopedic Surgery

Dupuytren's Contrature

Introduction

Dupuytren's contracture is a thickening of deep tissue (fascia) which passes from the palm into the fingers. Shortening of this tissue causes "bands" which pull the fingers into the palm. The cause of this is unknown but it tends to run in families and may indicate that you have Viking ancestry! The condition is progressive and the only treatment is surgery. If untreated, the fingers will be gradually pulled into the palm.

Surgery

Fasciectomy. Correction is usually done by removal of the fascia. The entire wound is stitched up in a zigzag manner which lengthens it but occasionally, a segment of the wound is not stitched, being left open to heal by itself (open-palm technique). [+INFO]

Fasciotomy. Occasionally, the bands are cut through small cuts in the palm. This can be done under local anaesthetic (awake with numbed hand) but is reserved for elderly who are unfit/unsuitable for more complicated surgery.

Amputation. Very rare in unoperated cases but may be preferred in a finger in which the bands have returned many times and where there has been previous nerve and vessel damage.

Complications

Scar. You will have a scar on the palm and finger
This will be somewhat firm to touch and tender for 6-8 weeks. This can be helped by massaging the area firmly with the moisturizing cream.

Nerve damage. The nerves running to the fingers can be damaged during the surgery and cause numbness in part of the finger. This complication is unusual in unoperated areas but becomes more common during repeat operations. If this occurs the nerve would be repaired immediately if possible.

Infection. Can occur after any operation. This would be treated with antibiotics.

Bleeding. Can cause a collection of blood under the stitches which is painful and which can cause problems with the wound. This is usually managed by removing some of the stitches but occasionally it is necessary to return to the operating theatre to stop bleeding. Tell the surgeon if you are on anticoagulants or aspirin.

Stiffness. About 5% (1 in 20) of people is sensitive to hand surgery and their hand may become swollen, painful and stiff after any operation (algodystrophy). This problem cannot be predicted but will be watched for afterwards and treated with physiotherapy.

Correction. It is often not possible to fully straighten fingers which are very bent at the time of operation, particularly if much of the bend occurs in the middle joint of the finger.

Skin loss. Portions of the zigzag scars and skin grafts can fail to "take" after the operation. This is unusual if you do not smoke and follow all the advice given.

Finger loss. This is extremely rare but can occur in fingers which have had many operations before and in patients who have diseases of blood vessels such as diabetes or scleroderma.

Recurrence. Dupuytren's contracture can return either at site of surgery or elsewhere in the hand. 

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