Dupuytren's disease treatment, Geelong

Dupuytrens Disease and medical plastic surgery

What is it?

  • Described by Baron Dupuytren in 1800s.
  • Fibrosis of a fascial layer in the hand.
  • Like scar tissue.
  • Not cancerous.
  • May take the form of nodules (lumps), cords or both.
  • Skin may be involved due to connections of the fascial layer.
  • Joints can be become bent over because of tightening of the fibrous tissue and this may progress over time.

What causes it?

  • Not fully understood.
  • May run in families.
  • Most patients have a Celtic background.
  • Weak associations with diabetes, liver disease, high alcohol intake and epilepsy.

What can be done for nodules?

  • Nothing.
  • Steroid injection if painful.

What can be done for cords?

  • Fasciotomy – cutting the cord.
  • Fasciotomy – excising the cord.
  • Dermofasciectomy – excising the cord and overlying skin if involved. Not everyone requires surgery – surgery is usually indicated if your hand cannot be placed flat on a table as a result of joint contractures.Collagenase injections(Xiaflex) – non surgical option for treating early
  • Collagenase injections (Xiaflex) – non-surgical option for treating early Dupuytren’s disease. This is a chemical way of breaking the cord. Offers a faster recovery though does not remove the disease

Day surgery

Anaesthetic
  • Local anaesthetic if very limited surgery required.
  • Arm block.
  • General anaesthetic.

The procedure

  • Fasciotomy on occasions where the patient is not well enough for an anaesthetic.
  • Fasciectomy to remove fibrous tissue.
  • Dermofasciectomy removes overlying as well as the fibrous tissue. This procedure is only required if the skin is heavily involved in the fibrotic process, and will usually require a skin graft taken from the forearm to replace the skin.
  •  Release of joints to straighten them, although there is a possibility that the joints may not be able to be straightened if they are bent over severely or have been so for a long time.

Recurrence

  • Even after successful surgery, in a number of patients the Dupuytren’s disease may recur either in the same fingers or other parts of the hand.

After surgery

  • Hand therapy and splintage is required to rehabilitate the hand. This is essential because even if surgery is a technical success, the end result might be suboptimal if the rehabilitation program is not followed.
  • Wounds heal within three to four weeks.
  • Patients can usually resume most duties in four to six weeks.
  • The scars may take three months or more to soften.

 Complications

  • The most common is a minor wound infection or a delay in wound healing which is usually easily treated.
  • Not infrequently there will be numbness in the fingers due to bruising of the nerves in the fingers. This usually resolves over the following few months. Rarely a nerve may be permanently damaged. This is more likely to occur if surgery is for recurrent Dupuytren’s disease.
  • Complex Regional Pain Syndrome – this is a rare condition seen in patients having hand surgery or sustaining a hand injury. This is characterised by pain, swelling, and stiffness in the hand. Treatment involves hand therapy and specialised pain treatments.