Named after the French Napoleonic Surgeon Baron Dupuytren, this is a common condition affecting the hand characterised by nodules or cords starting in the palm. In a third of patients the nodules will progress into cords which can cause digital contracture. The little and ring fingers are most affected. The aggressive form of Dupuytren’s, is characterised by radial (thumb and index) sided disease,bilaterality, ectopic disease (eg in the feet) and early age onset and strong family history.
The cause is unknown but we know that there is a genetic predisposition and people of Northern European (‘Viking’) heritage are particularly affected. It was previously thought to be associated with the ’good life’ (heavy smoking and alcohol consumption) but there is not enough evidence to back this up. There is an association with diabetes. Trauma /injury can accelerate the onset.
If function is unaffected then no treatment is necessarily required. The interventional options are:
Xiapex (collagenase) injections – depending on disease severity
Needle fasciotomy
Selective fasciectomy
Total fasciectomy
Dermofasciectomy (usually in the revision setting)- skin grafting
The available evidence does not support the use of radiotherapy for Dupuytren’s. Surgery is usually followed with splintage and hand therapy.
This involves an anaesthetic – regional ‘wide awake’ (whole arm numbed by an anaesthetist) or General Anaesthetic depending on patient preference. Usually day surgery. An extensive dissection is performed in order to identify and remove as much diseased tissue as possible and to visualise and protect the neurovascular (nerves/blood vessels) bundles. Post-operative elevation for a few days is required, plaster removal and splint application at 1 week, Hand Therapy to commence (and splint) at 1week post -op, wound check and removal of sutures 2 weeks. Hand therapy is an important component of treatment post-operatively and is required for several weeks/months depending on severity of disease.
