Dupuytren's disease treatment, Geelong
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?
- 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
- Local anaesthetic if very limited surgery required.
- Arm block.
- General anaesthetic.
- 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.
- 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.