Dupuytren disease

Dupuytren disease 2017-12-28T16:41:55+00:00

Dupuytren disease

Guillaume Dupuytren was a French surgeon who lived around 1800. He gave his name to this disorder affecting the aponeuroses of the hands. Aponeuroses are layered tissues located between the skin and underlying structures such as: muscles, nerves and blood vessels. They have a protective role against injuries. In certain people, this tissue grows significantly, creating tissue bubbles called “nodules” and extensions that retract at the finger level, starting from the palms and creating real strings that retract the fingers in a progressive manner.

The opening of the fingers in extension is also limited, while the closing (flexion) stays normal, as tendons are healthy. In severe cases, the fingers remain closed (flexed) at the level of the palm. The 4th and 5th fingers are the most commonly affected, but the disorder can affect all fingers and can also appear as nodules on the back of the middle joints. If thickening of the palmar aponeurosis occurs and compresses the nerves in the fingers, the sufferer can experience pain and sensitivity disorders.

The syndrome has genetic origins, thus explaining the fact that other members of the family can suffer from various other forms of the disease. The average age of the patients is 50. The disease is more common in men than women. The earlier its appearance in life, the more aggressive and rapidly progressive it is.

This thickening of the aponeurosis can also appear on the soles of the feet (Ledderhose disease) or in men, on the penis (Lapeyronie disease). Despite all this, there was no direct causality connection made between the Dupuytren disease and manual labour. Instead, an injury may trigger and worsen it.

For the time being, there is no etiological treatment for this disease. The current treatment is one without a curative purpose, the surgical procedure consisting in the removal or sectioning of the aponeurosis in the palm and the retracted fingers, depending on the chosen type of surgery.

Before the surgical procedure

According to prescriptions, there will be a preoperative review. Being a harmless disease, its benign, incipient forms are monitored, without a treatment being applied.

Once a functional discomfort appears, the doctor will recommend surgery.

Any drugs containing aspirin should be avoided for 10 days before the procedure.

It is imperative to stop smoking before the surgery.

Type of anesthesia and methods of hospitalization

The surgical procedure is usually carried out under regional anesthesia (axillary block, Bier block). General anesthesia is also available following the consent between patient-surgeon-anesthetist.

Hospitalization is usually necessary for 1 day, exception being made for specific situations:

  • 1 Patient’s request
  • 2 general anesthesia
  • 3 specific local or general evolution

Most of the plastic and cosmetic surgery practices are professionally done by Dr. Claudiu Filip.

Dr. Claudiu Filip

Surgical procedure

We can sometimes section the retracted palmar strings with a needle, under local or locoregional anesthesia (percutaneous needle aponeurotomy).

In most cases, an open surgical approach is necessary and different techniques are suggested: aponeurotomy, radical aponeurectomy (technique no longer in use), segmental aponeurectomy, partial aponeurectomy, dermoaponeurectomy.

In certain exceptional cases, we have to harvest skin grafts or flaps to cover large cutaneous substance losses as a result of multiple resections.

After surgery, postoperative instructions

Spontaneous healing occurs in two-three weeks, through dressings and bandages recommended by the plastic surgeon.

Average convalescence after this type of treatment is 1 month.

After the procedure, when retractions are old or severe, it is sometimes recommended to wear an orthosis or splints to allow for the relaxation of the operated fingers.

The recovery of mobility is not systematic, as long-term stiffened joints caused by retraction can present a postoperatively irrecoverable stiffness.

As with any other hand surgery, algodystrophy may occur and manifest htorugh painful swelling of the fingers and joint stiffness, requiring an immediate consultation with your surgeon for the record, kinesiotherapy and appropriate medical treatment.

Potential complications that need to be taken into account

  • Common surgical complications: hematomas, seromas, infection, skin necrosis, which can all extend the recovery and healing period
  • A very rare complication is the sectioning of a finger nerve during surgery, causing lack of sensitivity in a part of the finger, which will diminish in time, but can also leave a painful sequela. Your plastic surgeon will advise you on this complication
  • Recurrence and evolution of the disease are common and some patients are operated in several sessions for both hands.

The fact that you have resorted to a qualified surgeon will ensure that his/her professional training and skills will contribute to avoiding these complications or efficiently treating them, if necessary.

You will receive more information related to the surgery and postoperative advice during the consultation with Dr. Filip Claudiu.