Dupuytrens Contracture
Dupuytren's disease is a progressive disease of the fascia of the palm and digits in hand.
Dupuytren's disease is a progressive disease of the fascia of the palm and digits in hand. These patients develop thicknodules in the palm and subsequent contractureof the fingers.
Deformity of the hand occurs primarily at the level of distalpalmar crease (metacarpophalangeal-MCP joint) and mid finger crease (proximal interphalangeal-PIP joint level) resulting in functional limitations.
This disease process is presents a challenge in terms of both treatment and prognosis.
This disease is associated with repetitive trauma, alcoholism, liver disease, diabetes, smoking, chronic obstructive pulmonary disease, human immunodeficiency virus, cancers (paraneoplastic manifestation), and epilepsy.
Symptoms of Dupuytren's Contracture
- Impairment in hand shaking,
- Cannot wear gloves
- difficulty placing the affected hand in a pocket or on table
- and impairment in grasping large objects
Diagnosis of Dupuytren's Contracture
The characteristic progression from nodule to fibrotic cord with contracture of the affected palm and digits is pathognomonic for Dupuytren's disease.
Management of Dupuytren's contracture:
Management of dupuytren's contracture is mostly by surgery.
Non operative treatment can be tried in initial cases
- Splinting in extension position may prevent further progression of contracture. Splint must be worn continuously.
- Ultrasound therapy.
- Steroid injection.
Surgery
All pre op investigations are done
Surgical indications include greater than 30° of MCP joint contracture and any degree of PIP joint contracture.
- Percutaneous fasciotomy with a needle.
- Excision of all abnormal fibrous tissues within the palm and finger and closure with Z plasty flaps
- Dermatofasciectomy = Excision of the involved facia of the palm and fingers with skin and the defect is covered with grafting of the area.
A volar splint is given with the MCP and PIP joints placed in maximal extension. This splint reduces the risk of early contracture. Unoperated fingers are left free.
Post operative care of Dupuytren's Contracture:
- Hand therapy should be initiated as early as possible as allowed by postoperative pain and edema.
- The suture lines are dressed twice in a week and sutures are removed in place for 14 days.
- Early movements are started with splint in place. It can be removed and physical therapy for active and passive range of motion is begun at 7 days after surgery.
- Night splinting in extension is encouraged for 3–4 months.
- If Skin grafting is done, it is held in place with tie-over bolsters consisting of antibiotic gauze and this dressing is removed after 5 days.After that regular dressing are done till graft has completely taken up. In these patients range of motion exercises are delayed till postoperative day 14.
Dupuytren's Disease Images
Indivisual results may vary from person to person.
These pictures are shown for the purpose of education only.
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This surgery does not affect the ducts or the areas of the breast involved in milk production. Thus, it does not affect the breast feeding.
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