Dupuytren’s Fasciectomy is a surgical procedure designed to alleviate the symptoms of a disease called Dupuytren’s Contracture.
Dupuytren’s contracture occurs when scar-like tissue forms just underneath the skin of your fingers and in the palm of your hand. The tissue usually builds up over a number of months or years and can eventually force your fingers into an uncomfortable curled up position. It is this curled up position of the fingers that is named Dupuytren’s contracture; the contracture is caused by Dupuytren’s disease.
Cause of Dupuytren’s Contracture
It is more than 300 years since Dupuytren’s contracture was first discovered, and yet its exact cause is still unknown. However, the risk of the condition is often increased due to the following:
- Cirrhosis (alcoholic liver disease)
- Thyroid problems
- Genetic predisposition (the condition often runs in families)
Early symptoms of Dupuytren’s contracture are lumps or a hard knot of connective tissue that forms on the palm of the hand. The knot or lumps may start to thicken and appear wrinkled and become tender to the touch, although they are rarely painful.
The nodules on the palm gradually stretch into thin bands of collagen and progressively spread up, usually into the ring and pinky fingers, although others can be affected. As the bands get tighter, they pull the fingers in toward the palm and make it difficult to straighten out your fingers or rest your hand flat on a table. One hand is usually worse than the other, although fingers on both hands can be affected.
Diagnosing Dupuytren’s Contracture
Your doctor can generally determine if you have Dupuytren’s contracture by feeling for thickened scar tissue and testing whether your fingers pull inward. Other tests are rarely needed.
Before considering surgery, your doctor may attempt to alleviate the symptoms by performing a needle aponeurotomy which is a procedure used to straighten the bent fingers. It is also called percutaneous needle fasciotomy.
If undergoing needle aponeurotomy, your affected hand will be cleaned and injected with a numbing medicine. Once this has taken effect, the needle is used to make holes in the tissue whereby the doctor will then straighten your fingers in order to separate the tissue and release the pull on your fingers. Once the procedure is complete; your doctor may inject a steroid medicine into your hand to reduce swelling.
Needle aponeurotomy can be an effective form of treatment, although there is a high risk of the condition returning.
Collagenase injections are also used in the treatment of Dupuytren’s contracture. Collagenase is an enzyme that is extracted from a bacteria and is injected directly into a cord of the Dupuytren’s tissue. This will then break down the tight, contracted tissue. You will be required to return to see your doctor the following day once the enzyme has had the chance to break down the tight tissue. Your finger will then be manipulated to fully break down the contracted tissue.
Collagenase injections are not suitable for everyone, and doctors often feel that needle aponeurotomy or surgery is a better route as they offer more versatility.
Surgery for Dupuytren’s Contracture
The most effective treatment for Dupuytren’s contracture is surgery. The surgeon will assess your personal condition before deciding where and how to operate.
The operation will be performed either under a general anaesthetic where you will be asleep, or under a local anaesthetic where your hand is numbed. Whichever anaesthetic is used; you will not feel any pain.
Common methods for surgically treating the contracture range from cutting a fibrous band in your palm to removing all affected skin and replacing it with skin grafts. An incision is made directly on the top of the area of Dupuytren’s; the abnormal tissue is then removed and the incisions are stitched closed with a dressing applied. Depending on your reaction to the procedure and anaesthetic, you can usually leave the hospital the same day.
Recovery from Dupuytren’s Fasciectomy can be prolonged and involve a fair amount of discomfort. Following your surgery, your doctor may suggest you undertake physical therapy for a few months to help you recover strength and movement in your fingers.
You can often start using your hand a few days following the surgery but it could be between 4-12 weeks for you to fully recover. Bandages often need to be worn for several weeks, with a support splint required for a number of months, particularly during the first 3-6 whilst you are sleeping. Your hand may be uncomfortable and swollen but this should settle within the first few weeks.
Although surgery can improve the flexibility of your fingers, it does not cure Dupuytren’s disease. If your symptoms return, you may need another procedure.
Risks and Complications
Dupuytren’s Fasciectomy is generally a safe procedure, but as with all surgery, certain complications can sometimes arise. These include:
- Pain, although this can usually be alleviated with over the counter painkillers. Speak to your doctor to see which ones are safe to take
- Infection, often resulting in redness and inflammation
- Damage to an artery in the finger
- Incomplete correction of the contracture
- Return of the symptoms, resulting in a secondary surgery being required
- Stiffness of the finger joints, although physical therapy following the procedure will usually help
- Wound healing problems
- Extreme pain, stiffness and loss of the use of your hand. This is known as Complex Regional Pain Syndrome
The outlook for Dupuytren’s contracture following surgery is generally very effective, although the recovery period is very slow. However, the disease can recur within 10 years in up to 50% of cases.
At One Healthcare we can book you in to see a specialist Orthopaedic surgeon, usually within 48 hours, for an initial consultation. Dupuytren’s Fasciectomy is available at One Ashford Hospital in Kent and One Hatfield Hospital in Hertfordshire.
You can use your private medical insurance or pay for your Dupuytren’s Fasciectomy treatment. We offer competitive, fixed price packages as well as the ability to spread your cost with the option of 0% finance. If you are using your health insurance please do contact your insurer first for approval and let them know you’d like to be treated at either the One Ashford Hospital or One Hatfield Hospital.
Why One Healthcare
- Modern purpose-built hospital opened in March 2016 (Ashford) December 2017 (Hatfield)
- Fast access to diagnostics including MRI, Xray and Ultrasound
- Private, spacious, en-suite rooms
- Specialist Physiotherapy and nursing teams
- Little or no waiting time
- ‘Ultra clean air’ theatres
- Freshly prepared food
- Calm, dignified experience
Mr Justin S Chatterjee
Consultant Plastic, Reconstructive Breast and Hand Surgeon
One Hatfield Hospital
Mr Rajeev Sharma
Consultant Orthopaedic Surgeon - Upper Limb Surgery (Shoulder, Elbow, Wrist and Hand)
One Hatfield Hospital