Dupuytren's disease

What does Dupuytren's contracture | Dupuytren's disease (palmar fibromatosis) mean?

Baron Guillaume Dupuytren first described this condition in the 18th century, hence the name.

Dupuytren's contracture is a nodular or cord-like thickening of the palmar connective tissue in the palm of the hand (the so-called palmar aponeurosis), which is located below the skin and above the flexor tendons.

The disease often begins with a nodular thickening of this palm fascia in the palm of the hand (palmar fibromatosis) and often spreads to the little finger and ring finger, but can also occur on other fingers or the thumb. This leads to a slow retraction of the fingers into the palm of the hand, so that the affected fingers can no longer be fully extended. The disease also occurs more frequently in families, in combination with metabolic diseases such as diabetes, liver damage, as a result of chronic mechanical irritation or spontaneously. Men are affected more frequently than women.

The nodular thickening can remain limited to the palm of the hand (stage 0) - surgery is then indicated if pain is present. If the cord-like tissue extends to the fingers, there are 3 further stages according to Tubiana, which are accompanied by an increasing retraction of the fingers. In the highest stage, the finger is almost completely retracted into the palm. At this stage, surgical correction is associated with increased risks of circulatory disturbance and loss of sensation or even loss of the finger and impaired wound healing of the skin, especially in the case of a recurrence of the disease. However, it is also possible that the disease remains at a certain stage or does not deteriorate or only deteriorates very slowly.

Depending on the degree of suffering and severity of the contracture, you should decide for yourself when you would like to undergo surgery. We will of course be on hand to advise you.

Information on the operation

You should not have any open wounds or scratches on the hand in question before the operation, as this increases the risk of infection.

If the skin is very rough and hard, the hand should be treated with a well-lubricating hand cream several days before the operation and a disinfectant hand bath should be carried out the evening before the operation.

During the operation, the cord-like thickened tissue is completely removed from the palm to the middle or end phalanx. We call this a "partial fasciectomy or aponeurectomy". The operation allows you to stretch the affected finger almost completely again, which was not possible before. If several fingers or even the thumb are affected, we will decide together in which order the operation will be performed.

The operation is performed in a so-called "tourniquet", i.e. a blood pressure cuff is applied to your arm and inflated in order to be able to operate with as little bleeding as possible and under good visibility. In the early stages of the disease, the incision is made in a zigzag shape (according to Bruner) so that no scarring of the skin occurs later on. In more advanced stages, the incision is made in the form of small local skin displacements (so-called Z-plasty according to Iselin). The thickened fascia strand is then removed from the surrounding tissue in a detailed and careful dissection with protection of the surrounding vessels and nerves using magnifying glasses.

In this case, individual finger nerves can take an unusual course around the fascial cord, so that by detaching and holding the nerve aside, the affected finger may experience reduced sensation for a few weeks.

If the contractures have been present for a long time, it may be necessary to surgically release the middle finger joint in the form of a so-called "arthrolysis".

If a skin graft is required to close the wound in advanced stages or recurrences, this can be taken from the arm or leg.

After opening the tourniquet and stopping the bleeding, a small wound drain is inserted and the skin is closed with many small individual sutures. A compression bandage with compresses, absorbent cotton and elastic bandage is applied, and a plaster splint may be used as a stretching splint for a few days after the operation.

Hospital stay and anesthesia

The operation can be performed under general anesthesia or local anesthesia of the brachial plexus (plexus anesthesia). The surgical procedure can be performed on an outpatient basis; in the case of recurrences, hospitalization is recommended due to possible circulatory disorders of the fingers.

Alternative treatment methods

If you are not suitable for a surgical procedure due to serious pre-existing conditions, a so-called "percutaneous needle fasciotomy" (cutting of the connective tissue strand through the skin) could be performed on a single strand under local anesthesia of the finger as an alternative.

This procedure can only be used if there is a narrow strand of connective tissue, preferably in the metacarpal area. The cord is punctured several times through the skin with a thin cannula and can thus be broken up. No skin incision is necessary. However, this needle fasciotomy only cuts the cord and makes the finger more extensible, the cause (the cord itself) remains in the hand. A recurrence can recur at an early stage.

We do not recommend injecting a specific enzyme ("collagenase") into the cord, as this can lead to serious complications such as inflammation of the hand and dissolution of tendon or nerve tissue with corresponding loss of function.

We will work out the exact procedure and the best individual treatment plan for you in a detailed consultation with you.