Dupuytren’s Contracture or palmar fibrosis

Hand Surgery is beside the Aesthetic Surgery I do, one of my favorite surgical fields. It requires a profound knowledge of the anatomy and superior surgical skills as the hand is packed with tendons, nerves and arteries in close proximity.

What is Dupytren’s Contracture?

The Dupytren’s contracture is a disease of the connective tissue of the hand mainly the palmar aponeurosis which lies right under the skin of the palm and fingers. In patients suffering from this disease, the fibers of the palmar aponeurosis start growing, thickening and contracting. This leads to the fingers being bent in the base joints.  Extending the fingers is not possible, but flexion into the fist still works. The disease usually starts on fingers 3 to 5 (middle to little finger), but can also be seen at the index finger or thumb. In very severe cases all fingers can be involved.

We know four stages with stage 1 being the beginning of the disease with the Dupuytrens cord just being visible to stage 4 being the most severe stage with flexion of the fingers into the fist making them literally unusable. The exact cause is still unclear but linked to genes more spread in Europe and North America.

How Dupytren’s contracture is treated?

In the beginning, the disease can be treated by physiotherapy or application of night splints to keep the fingers stretched. If it progresses to stage 2 and beyond invasive measures have to be taken. In recent years a minimal invasive treatment has been quite popular which uses percutaneous needles to cut the chords and straighten the finger. However, it cannot replace the surgery as recurrences are high. If a surgery is necessary, all affected connective tissue chords will be removed and the underlying nerves, vessels and tendons will be spared. Depending on the severity of the case and in recurrent cases it can be a demanding and time consuming surgery which should be left for the very experienced and trained hand surgeons.  

Do you need physiotherapy after the surgery?

After the surgery usually a splint is applied to keep the fingers straight for 7 to 14 days. The skin sutures can be removed on the 12th to 14th day. After that physiotherapy will help in regaining full function quicker. Most patients can resume their normal daily activity 2 weeks after the surgery.

As a matter of fact, the surgical treatment of Dupuytrens disease was a routine procedure during my time in Germany. Almost every day we would treat patients with this condition. Having operated on more than 1000 of patients the outcome in my hands in reliably positive.

This is of particular importance as the recurrence rate of a Dupuytren is reported to be very high in the literature especially if a non-experienced surgeon performs the surgery.

Whoever suffers from this condition should, therefore, seek for hand specialist with a proven track record of successful surgical treatments of Dupuytren’s disease and sufficient experience in the field.

Last but not least surgeons who operate on this disease should also be versed in the repair of vessels and nerves to be able to reconstruct these structures if during the surgery damage to them happens.