Dupuytren’s contracture

Dupuytren’s contracture - Dr. med. Daniel Münch

The case of a gnarled or callus-type thickening of the surface of the palm is designated as a so-called Dupuytren’s Contracture, named after the man who discovered it, the French Baron Guillaume Dupuytren (1777-1835). This pathological deformation of the connective tissue in the palm of the hand is often only noticed in an advanced stage. First signs of this disease are knotty nodes that can be felt under the skin of primarily in male patients. Generally, there is no pain. In its continued progression, it could be that several more or less thick strands are formed on the tissue bands leading to the finger joints. Sometimes these strands contract so strongly that the affected fingers can no longer be extended.

The cause of this disease is unknown, but a tendency in families as well as a connection to diabetes and liver diseases is prevalent.  The surgery is the only sensible treatment. The operation should be performed either when pain exists, the patient feels hampered in his functionality or if one or more fingers can no longer be fully extended.

Dupuytren’s contracture - Dr. med. Daniel Münch
Markings to guide skin incisions

If the gnarled thickening is not too extensive, no more than 2 fingers are affected and the ability to extend the finger not overly limited, then the operation can be performed on an outpatient basis. However, a requirement is also the social environment at home and the necessity of a household help organized, mostly for older patients. It is important for patients to be informed of the risks of complications such as nerve damage or wound healing disorders.  They must also be aware that sometimes the treatment period after the operation can last up to several weeks, that a full extension of the affected finger does not always result and that sometimes the condition can reoccur. Depending on the situation, a physiotherapy treatment is also required after the surgery.

The gnarled thickening and strands are loosened and cut out during the operation, while taking greatest care to protect the main nerves and blood vessels.  Depending on the situation, longer skin incisions are required, sometimes in a Z-formation, so that the wound can be sealed again with the fingers straightened. Strict elevation is advisable in the first few days at home, and the operated finger should be passively fully extended several times per day

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