Dupuytren's disease treatment, Geelong

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.

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

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. This is not a cure.
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. Currently Xiaflex is not available in Australia.

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.

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.

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.