Dupuytren’s Contracture

Introduction Dupuytren’s contracture is a thickening of deep tissue (fascia) which passes from the palm into the fingers. Shortening of this tissue causes “bands” which pull the fingers into the palm. The cause of this is unknown but it tends to run in families. The condition is progressive and the only treatment is surgery. If untreated, the fingers will be gradually pulled into the palm. Fasciectomy Your Dupuytren’s contracture will be corrected by removal of the abnormal fascia and relaxation of the overlying skin. The entire wound is stitched up in a zigzag manner which lengthens it but occasionally, a segment of the wound in the palm is not stitched, being left open to heal by itself (open-palm technique). Dermofasciectomy In some situations it is necessary to also remove the overlying skin if it is affected by the disease or previous operation. Amputation Very rare in unoperated cases but may be preferred in a finger in which the bands have returned many times and where there has been previous nerve and vessel damage. Post-Operative Care  Hand elevation is important to prevent swelling and stiffness of the fingers. Remember not to walk with your hand dangling, or to sit with your hand held in your lap.  You will be initially placed in a bulky dressing consisting of gauze, plaster of paris and tensor bandage to rest the hand. The dressing will be removed after 3-5 days and then be left open at this stage, if possible, to allow mobilization of the fingers. The open-palm technique usually requires dressing to be applied to the palm for 2-3 weeks while mobilization is performed in the usual way.  At this time, you will see a hand therapist who will fit you with a splint and give you specific exercises to perform. The splint is to be worn at night for 6-12 weeks to keep the finger straight. During the day, the hand should be exercised and you should perform normal light activities. You may require ongoing therapy for range of motion and strengthening.  Your stitches will be removed one to two weeks after the operation. Following this the scar will be somewhat firm to touch and tender. This can be helped by firmly massaging the area with moisturizing cream. At this stage it is safe to get the hand wet in the bath or shower. The scar and the surrounding skin often become very dry and will be more comfortable if a moisturizer is applied, including the scar itself.  A Hand Therapist will see you for scar management. It is often not possible to fully straighten fingers that are very bent at the time of the operation, particularly if much of the bend occurs in the middle joint of the finger. This can sometimes be improved with splinting and exercise later after the operation. Duputren’s contracture can return either at the site of surgery or else where in the hand.  You can usually drive a car a couple of weeks as long as you are comfortable and have regained good finger movements. Timing of your return to work is variable according to your occupation and this should be discussed. Please call the Office or your Family Doctor if:  The prescribed medication does not provide adequate pain relief  The dressing/cast is too tight or uncomfortable  Numbness persists  You have a fever Risks of Surgery Nerve Damage The nerves running to the fingers can be damaged during the surgery and cause numbness in part of the finger. This complication is unusual in unoperated areas but becomes more common during repeat operations. If this occurs the nerve would be repaired immediately, if possible. Infection Any operation can be followed by redness and tenderness which may indicate infection. Do not apply antiseptics. It would be treated with antibiotics.