This is a progressive condition in which a layer of tissue under the skin of the palm and fingers changes character and starts to form nodules which become cords that slowly pull the fingers down into a permanently bent position.
Early Dupytren’s Contracture
It usually affects people in their 60’s and older and often it occurs on both hands. There may not be much to see when it first starts but once the fingers start to bend and you can’t straighten them then it can start to be a functional problem. Surgery is usually offered once you can’t get your hand flat on the desk.
Moderate Dupytren’s Contracture
I have Dupytrens but it isn’t causing me any problems even though I can’t get my hand flat. Should I have surgery to stop it getting worse?
That is a very good question because it will definitely get worse and surgery is easier before the deformity gets too severe. What I can do in some cases is a much smaller operation where, under local anaesthetic, I make a few small stab incisions about 1.5 cms apart next to the cord and use the knife to divide the cord. This gives an excellent correction of the deformity very quickly and allows a rapid return to function. However the disease is always there and it can recur.
What does the ‘big’ operation involve?
Severe Dupytren’s Contracture
Once the deformity has progressed and gone beyond the scope of the ‘little’ operation then it is a much bigger deal to sort things out. I do this operation under a general anaesthetic and it means making a zig-zag incision crossing the deformity, peeling flaps of skin away and slowly and carefully excising the diseased tissue from the palm and up into the fingers and starightening them out. It is done as a day-case and you will be in a sling afterwards for a few days. The bandages are taken off after 10 days and the stitches are taken out. I recommend that you wear a splint at night for another 4/5 weeks to keep the fingers out straight as they naturally want to curl up when you are asleep. You will need therapy once the bandages are off to help get the function back in the hand.
It can be a bit inconvenient for a couple of weeks but well worth it to get a better finger back.
– for baths and showers while the bandages are on you should put your hand in a rubber glove and tape it round your forearm.
– you should be able to drive straight away even with the splint but that does depend a bit on which side is operated on, do you have an automatic car and individual pain responses.
– it will probably be about 6 weeks before the scar has settled enough and the function improved enough to allow you to do gripping activities and sports (gardening, golf etc)
Are there any risks?
The obvious mantra is that all operations carry risks but there are specific ones related to this operation. The biggest risk is damaging the nerves that supply feeling to the fingers because the diseased tissue engulfs them as it spreads down the finger and they can be bruised or even inadvertenly cut when disecting out the Dupytrens tissue.
