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Dupuytren's Disease
















What is Dupuytren's disease?

Dupuytren's disease was first described in 1831 by a surgeon called, not too surprisingly, Dupuytren. It is thought to be of Scandinavian origins, notably of the Vikings.

It is essentially caused by abnormal thickening of the palmar fascia, which is a tough layer of tissue that lies just under the skin of the palm. The condition affects the hands, whereby tight scar-like bands extend from the palm up to the fingers (called Dupuytren's cords). As these cords tighten with time, they cause the fingers to curl and the fingers can no longer be fully straightened. Eventually the fingers may be pulled into the palm and cause impairment to hand function.

It can also affect the soles of the feet, causing tightening of the skin and curling down of the toes.The penile shaft may also be affected, and is known as Peyronie's Disease. The mid-shaft is usually affected, causing gradual bending of the shaft towards the affected area. This may lead to such bending that intercourse may become impossible.



What are the symptoms of Dupuytren's disease?

Often the first signs of Dupuytren's disease are hard nodules in the palm. Pain, numbness and tingling are not usual symptoms; the main symptom is curling of fingers, toes or penis as described above.



What are the risk factors for Dupuytren's disease?

There are a number of risk factors, including:

  • Age - Dupuytren's is more common with older age, with average onset at about 50 years old

  • Sex - Dupuytren's disease is four times more common in males

  • Genetic - Dupuytren's tends to run in families (patients may recall 'grandad having curled fingers')

  • Epilepsy - anticonvulsants are thought to contribute to development of Dupuytren's

  • Alcoholism, diabetes, smoking - thought to contribute to development of Dupuytren's

  • Manual work - this may be an aggravating factor

At present, however, the exact cause of Dupuytren's is unknown and is the subject of intense research.



What are the treatments for Dupuytren's disease?

Dupuytren's can cause a nuisance, as fingers may get caught in pockets, handling money becomes cumbersome, and daily tasks become difficult. People usually seek help when they can no longer perform their usual tasks, but this is often quite late in the disease process. Many surgeons believe that it is the right time to have surgery if you fail the 'table top' test - put your hand flat on a table, palm facing down. If you cannot get your hand flat on the table, then it may be time for intervention.

Sometimes, wearing splints at night-time can help to slow progression of Dupuytren's - the splints are gradually altered over months to eventually straighten the fingers. Often, however, splints merely 'buy time' before a procedure is required. There are a number of procedures used to help combat Dupuytren's, depending on the severity of disease and surgeon's experiences and preferences:

  • Needle fasciotomy - this can be an office-based procedure. A needle is pushed into the Dupuytren's cord, then moved within the thickened cord, to divide it. Although some surgeons advocate this procedure for mild disease, others do not offer it as treatment; it depends on surgeon experiences and opinions

  • Segmental fasciectomy - a small incision is made in the palm, and part of the diseased tissue is removed under direct vision. Useful for milder forms of Dupuytren's

  • Fasciectomy - this is for more advanced forms of Dupuytren's. The diseased tissue is removed from the palm up into the fingers. To access these areas, larger skin incisions are needed. If the finger has been flexed for a long time, then the skin may have 'shrunk down'. When straightened at operation, there may therefore be too little skin and occasionally a skin graft is needed to 'fill the gaps'. The graft may be taken from the arm, neck or tummy area and leaves a small scar.

  • Dermofasciectomy - the diseased tissue is removed along with the overlying skin. It is believed that this may slow down or in fact prevent any recurrences. The drawback is that a skin graft is often required.

After surgery, a splint is often worn for about two weeks and physiotherapy is required to keep the joints mobile.



What are the risks of procedures for Dupuytren's disease?

  • Recurrence - it is very common to have recurrences, although it is often in fact another different cord forming rather than recurrence of the original cord. It is generally thought that the use of skin grafts helps to prevent recurrence

  • Stiffness - whilst the hand is kept splinted, the other joints can become stiff. Physiotherapy is used to help reduce this risk

  • Graft failure - if grafts are used, then can occasionally fail to adhere to the underlying tissue. If only a small part fails, this can usually be allowed to heal on its own, but if required the graft may need to be re-performed

  • Nerve or vessel damage - the fine nerves and vessels of the finger can become wrapped up in the diseased tissue, spiralling around each other. Whilst the surgeon will try to carefully preserve these structures, they can be inadvertently cut, leading to numbness of the affected side of the finger



Any procedure involving skin incision can also result in unfavourable scarring, wound infection, or bleeding. This list of risks is not exhaustive, and you should discuss possible complications with your specialist. Whilst these risks will seem very worrysome, and indeed can be serious, it should also be borne in mind that many people have no postoperative problems whatsoever.

The information provided is as a guide only and you should discuss matters fully with your specialist before deciding if this is the right procedure for you. Please also read our disclaimer






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