Dupuytren’s contracture is the name of the disease which engages subcutaneous lining (surface fascia) of the palm and fingers which leads to subcutaneous nodules, glimpses and eventually flexing of the fingers (flexion contractures). In the advanced phase, it also engages the skin and causes the skin to contract and shrink. Dupuytren’s contracture most frequently affects, the palm of the hand, a ring finger and a pinky finger. The real cause of Dupuytren’s contracture occurrence is still unknown. It is considered that this disease is hereditary and it is more common with men (10:1). It usually occurs after the age of 40. The course of the disease is extremely difficult to predict, it cannot be known how quickly the disease will progress and to what extent it will develop.
The disease was named after the French surgeon Dupuytren who set the essential principles in surgical treatment of this disease in 1872. The surgery removes, thickening, altered palmar aponeurosis and fibrous nodes. Dupuytren’s contracture surgery performs a plastic surgeon or a surgeon or a surgeon engaged in a hand surgery. Plastic-reconstructive procedure gives good results if the surgery was performed in time and if adequate postoperative rehabilitation was conducted.
It is necessary to know that during this disease besides thickening of the fascia, there are changes in other structures of the hand. Skin loss is possible, as well as shortening of neurovascular structures, contracture of the joint capsules and ligaments, shortening of the flexor tendon membranes. These are all the factors that influence the final result of the treatment. It is also good to know that Dupuytren’s contracture has tendency to reoccur after the process of treatment.
CANDIDATES FOR THE PROCEDURE
The surgery is indicated with patients in whose case thickened membrane causes disturbances or the finger can no longer be fully extended.
Procedure is preceded by a consultation examination where you will, after the inspection and seeing the condition of the hand, get the basic information about the surgery, postoperative period and following rehabilitation.
PREPARATION FOR THE PROCEDURE
For the surgery under the general anaesthesia, it is necessary to do standard blood and urine tests: complete blood count, erythrocyte sedimentation rate, coagulogram, blood glucose levels, urea and creatinine concentration, complete urine, to record electrocardiogram (ECG) and, if it is necessary, do the internist examination. All these examinations can be done in the Polyclinic for aesthetic and plastic surgery Arcadia.
If it is possible to perform the procedure under the local anaesthesia, complete screening is not necessary. You are going to get detailed information during the consultation examination from your surgeon.
ADMISSION TO POLYCLINIC
Admission to polyclinic is appointed in advance via phone and it is possible during the morning hours on the day of surgery, or the evening before the procedure if it suits you better. After situating you into your room, taking anamnestic data, doctor’s examination, taking photos of the hand and if necessary an examination by a specialist anaesthetist, are to follow.
Plastic-reconstructive procedure of Dupuytren’s contracture is conducted under the general or regional anaesthesia. In case this is a lesser degree of a disease, the surgery can be performed under the local anaesthesia.
There are more surgical methods of treating Dupuytren’s contracture. Depending on the progress of the disease, the method is being chosen. Today, the most commonly used are:
- Limited removal of a diseased membrane (resection of the palmar fascia)
- Complete removal of the membrane (fasciectomy)
- Removal of fascia and affected skin (dermo-fasciectomy)
- In advanced disease, finger amputation
After deformity correction, skin defect often remains and care of is taken through some of plastic-reconstructive procedures (e.g. Z-plastic) or the wound is left partially opened to heal on its own.
IMMEDIATE POSTOPERATIVE PERIOD
It depends on the method of plastic surgery of Dupuytren’s contracture. You can go home on the same day, or 24 hours after the surgery. Bandage and malleable (plastic, cast or metal) are worn on the hand, and if a drain is installed, it should be taken 24 hours later. Stitches are removed within 7 to 10 days. Physical therapy starts after the removal of stitches or after the complete wound healing, which is very important during the postoperative period treatment of Dupuytren’s contracture.
Early complications with plastic surgery of Dupuytren’s contracture can be extended bleeding of the operated area, hematoma formation and wound inflammation. Very rare complications are skin necrosis and lost sensation on the fingers of the fist.
The aim of surgical treatment od Dupuytren’s disease is realising the contracture and restoring the function of the hand. If there is contraction on both hands, the surgery on another hand is performed after the full recovery from the previous surgery. Proper choice of the surgical procedure can correct deformity and achieve the full function of the fist.