Dupuytren's Disease

What is Dupuytren's disease?

It is a disease whose exact cause and factors influencing its progression remain mysterious despite scientific advances. However, its manifestations have been known for a long time: it is a fibrous thickening of the aponeurotic septa of the hand.

In the "normal" state, these septa are supple and thin, organized according to a very complex architecture defining the respective spaces for nerves, arteries, tendons... The invasion of these septa by collagen leads to their retraction and stiffening.

This results in the appearance of firm nodules, an increase in the depth of hand creases, then the occurrence of rigid cords permanently flexing the fingers. The condition mainly affects the little finger, ring finger, thumb and palm.

The progression is inevitable but unpredictable, sometimes slow, insidious and continuous over decades, sometimes in the form of painful inflammatory flares causing acceleration of finger flexion within a few weeks.

The aponeurotic septa of the hand in normal state

Dupuytren's disease with nodules and cords

The disease is characterized by retraction and thickening of the septa, forming nodules (N) and cords (C)

Risk factors

Men in their fifties are more often affected
Northern European populations
Frequent hereditary component
Conditions starting in the thirties are often more severe

I have Dupuytren's disease, what can be done?

There is no drug or surgical preventive treatment for the disease, or that would slow down or stop its progression.

Current treatments also do not prevent disease recurrence but aim to limit its consequences.

When to treat?

When finger retraction is absent and "the hand can be laid flat", it is generally not yet time to propose treatment
On the contrary, when finger flexion has begun, treatment is indicated

Classical surgery

Classical surgery aims to remove all the thickened pathological fascia to restore maximum possible extension (because when finger contracture has been present for many years, the established joint stiffness does not always allow a complete result).

It is difficult, demanding and specialized surgery because the cords have an unfortunate tendency to wrap around nerves and arteries, and the skin incision must be precisely planned to "bring" enough skin to the palmar surface of the finger and allow closure in complete extension.

In rare cases where retraction is extreme, an area can be left open (McCash technique) and heals very well despite impressive initial dressings.

Classical incision for Dupuytren's disease

Cords frequently wrap around digital nerves

I'm going to have Dupuytren's surgery... what will happen to me?

Surgery is most often performed on an outpatient basis under regional anesthesia.

Night splint

At the first dressing change, an extension splint will be custom-fitted and worn at night (for several months) to maintain the result obtained during surgery.

Healing

Two to 4 weeks of healing will be necessary with dressings, which may seem impressive due to the size of the incisions and possible suffering of certain skin areas, whose healing - although slower - will be achieved through dressings.

⚠️ Early mobilization - ESSENTIAL

Finger mobilization and hand use during the day are encouraged from the day after surgery, often with the help of physiotherapy to be planned from the first days following surgery, when the stitches are still in place.

Indeed, it is essential to bend the fingers completely and without delay, so that tendons and ligaments do not have the opportunity to retract or "stick".

Delay in starting mobilization often results in a less good outcome or more prolonged rehabilitation.

Scar massage

Massaging the scar 6 times 10 minutes per day will soften the very rigid and thick scar in the operated area. This massage must be very firm to soften the hard scar, which is no longer Dupuytren's disease.

Is Dupuytren's surgery risk-free?

No, of course not. Although it is a codified, routine and mastered procedure, the risk exists, as with any surgery.

We mainly find, even if all precautions are taken:

Healing difficulties (frequent, sometimes impressive but rarely serious or requiring reoperation)
Hematoma
Local infection
Algodystrophy
Anesthetic complications
Transient finger anesthesia from nerve shock or stretching, rarely permanent from section of a nerve branch (as cords are sometimes difficult to separate from nerves)
Scar hypersensitivity

Recurrence of cords and nodules is not a complication per se, as it corresponds to the natural evolution of the disease. As with the first treatment, new surgery will be discussed again if it becomes impossible to "lay the hand flat". It is surgery often more demanding than the first treatment.

What is the risk of not having surgery?

If retraction becomes significant, the inability to open the hand can considerably hinder daily activities.

Moreover, when finger flexion is significant and has been present for many years, both surgery and postoperative rehabilitation are more difficult and final extension incomplete, less good than with "timely" treatment of the disease and its possible recurrences.