Dupuytren’s Disease

Diagnosis

Dupuytren’s disease is diagnosed though listening to your symptoms and history, and an examination of the wrist and hand and note the degree of stiffening (contracture). The feet may also be examined for nodules. Further tests are not normally required to aid the diagnosis.

Treatment options

Once the hand can no longer be easily placed flat on a table, or the finger is getting in the way of daily activities it may be time to discuss surgical options. There are 3 main surgical options which our consultant hand surgeons can discuss with you:

• Fasciotomy: A small incision is made and the fibrous tissue stopping the finger from straightening is divided. Sometimes a plaster cast followed by a splint is used to help maintain the correction. Our research suggests that a steroid injection 6 weeks post operatively may reduce the risk of reoccurrence. There is a 50% risk of the contracture returning.
• Fasciectomy: This is the most common surgical option. A zig-zag incision is made which helps with scarring problems, and the affected tissue is cut away. Incisions in the palm are partly unstitched and the finger wounds are sutured with absorbable stiches. Sometimes a plaster cast followed by a splint is used to help maintain the correction.
• Dermo-Fasciectomy: If your case is very advanced, you are young, or you are having the surgery repeated due to re-occurrence a fasciectomy will be completed (as above), however some of the skin from the affected area will be removed, and replaced with a skin graft (taken from the wrist or elbow) which helps to reduce the risk of the Dupuytren’s tissue from returning. Absorbable stiches are used, and sometimes a plaster cast followed by a splint is used to help maintain the correction.
• Post operative care: Careful follow up plans are key to success of the operation with physiotherapy and a splint if indicated. Movement is essential and most of the movement gained occurs within the first 6 weeks, and so this time is very important for carrying out the prescribed exercises. ‍

Typically performed under local anaesthetic, i.e. making the area numb, but can be performed under a general anaesthetic if requested.

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