Dupuytren’s Surgery

Dupuytren’s contracture is a condition that affects the hands and fingers. It causes one or more fingers to bend into the palm of the hand. It can affect one or both hands and it can sometimes affect the thumb.

Dupuytren’s contracture occurs when the connective tissue in the palm thickens. Often the tissue thickens in one small area first and a “nodule” forms (a small, hard lump about 0.5-1cm) under the skin of the palm. The nodule sometimes feels tender to begin with, but this usually passes.

The nodules are non-cancerous (benign) and the condition is not life-threatening for those who develop it, although it can be a nuisance to live with. Over time, the nodules can extend and form cords of tissue. These cords can shorten (contract) and, if the cords run along a finger or thumb, they can pull it so it becomes bent towards the palm. These contractures are often mild and painless, but they can get steadily worse over time. Sometimes, the term Dupuytren’s disease (palmar fibromatosis) is used instead of Dupuytren’s contracture, because not everyone with the condition will develop contractures.

Many cases of Dupuytren’s contracture are mild and don’t need treatment. Treatment may be helpful if the condition is interfering with the normal functioning of your hand.
Non-surgical treatments include radiation therapy and injections with a medication called collagenase.

Alternatively, a minor procedure that involves using a needle to cut the contracted cord of tissue (needle fasciotomy) may be used in the early stages of the condition.
In more severe cases, surgery can help restore hand function. The two most common surgical techniques are:

Open fasciotomy – where the shortened connective tissue is cut to relieve tension
Fasciectomy – where the shortened connective tissue is removed

Surgery for Dupuytren’s contracture cannot always fully straighten the affected finger or thumb and the contracture can recur after surgery. If a contracture does recur, further surgery may be possible.

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