Dupuytren's Contracture Repair

The disease begins slowly and insidiously. First, painless swellings are seen in the palm, particularly in line with the 4th and 5th fingers. Gradually the swelling increases and begins to thicken in the form of a band. As the swelling and hardening in the skin increase, the flexibility of the fingers is affected. When the patient places the palm on a flat surface, the palm does not touch the surface and takes on a dome shape. As the disease progresses it can also affect the tendons and the neighbouring vessels and nerves. It becomes increasingly difficult for the patient to open the finger. For this reason, washing the hands, putting on gloves, clapping and grasping objects are impaired. Dupuytren's contracture is generally not painful, but the contracture that develops due to thickening of the fascia as a result of the disease, and the deformity formed by puckering of the skin and adhesions in the tendons, are bothersome.

Physical examination is sufficient to make the diagnosis of the disease. Dimpling of the skin over the affected area is quite characteristic. There may also be a strip of tissue under the skin that cannot be moved. A change in the position of the wrist does not affect the contracture. After the diagnosis is made, it is important to keep the progression of the disease under observation. If the fingers cannot be opened when the hand is placed on a flat surface with the palm facing down, surgical treatment may be needed. Even if the test result is negative, you need to repeat this test from time to time. If the clinical picture worsens on repeated examinations, a decision to operate may again be made. Although it is mostly not painful, the progressive decrease in the flexibility of the fingers may over time cause discomfort in patients. Although all or most of the normal ability to move frequently returns after surgery, the condition may recur in some people.

The basic aim of treatment is to correct again the impaired functional capacity and the deformity in the affected hand and to prevent recurrence. In the early stages, cortisone injection can be given in suitable patients to slow progression. But the patient must always be under a doctor's supervision, and intervention should be made with an appropriate surgical procedure as soon as the inability to open the finger begins. Surgery is unnecessary for nodules that do not cause tension and restriction of movement in the finger.

Many surgical methods have been described, and the method to be applied may vary according to the surgeon and the patient. The later the surgical intervention, the lower the chance of obtaining a mobile finger after the surgical intervention performed.

The operation consists of removing the contracted tissues and, in some cases, transplanting skin taken from other parts of the body to this area (graft), or other surgical interventions. The hand will be bandaged together with the fingers in an open position for a few days or weeks, and physical therapy consisting of finger and hand exercises will then begin.

Complications after surgery can be listed as problems related to wound healing, infection, haematoma, nerve injury (neuroma-hypoaesthesia), artery injury (cold intolerance-impaired circulation) and joint stiffness. Reflex sympathetic dystrophy may develop.