Dupuytren's Disease
Dupuytren’s disease, also known as Dupuytren’s contracture or Vikings’ disease, is a prevalent condition typically occurring in middle age or later, with a higher prevalence in men than in women. Although the cause of Dupuytren’s disease remains unknown, it exhibits a higher prevalence in Caucasians and often runs in families. While diabetes, smoking, and high alcohol consumption may co-exist, these associations are not always clear. There are no clearly defined occupational associations. Occasionally, the disease may develop following hand injury or surgery.
The process begins with the formation of firm nodules in the supporting ligaments beneath the skin of the palm. These can extend to form cords which cross the joints. Over a variable amount of time the cords shorten, pulling the finger towards the palm of the hand, known as a contracture. As the disease progresses, the fingers become increasingly bent, and may become fixed in this bent position. The most commonly affected fingers are the ring and little fingers. Less commonly, the disease affects the thumb and index fingers, with the web between these digits narrowing. Disease progression is variable but typically develops slowly over months to years. It tends to be more aggressive in younger patients.
Some individuals with Dupuytren’s disease may also exhibit nodules over the back of the finger knuckles (Garrod’s knuckle pads) and lumps on the soles of the feet. Rarely, men may develop a curvature of the penis.
While there is no cure for Dupuytren’s disease, treatment options aim to address symptoms and improve hand function. Unfortunately, non-surgical options such as injections and splintage are limited in what they can reliably achieve, and surgical intervention is the mainstay of treatment. Surgery does not eliminate the disease entirely, and recurrence may occur over time. The disease may develop in other digits subsequently or even in the other hand.
Surgery is recommended when it becomes difficult to lay the hand flat on a table or when functionality of the hand is affected. The type of surgery and its timing should be discussed with your surgeon.
There are a number of techniques that can be used, depending on the configuration of the disease and the preferences of individual surgeons:
Surgery is typically performed under a general anaesthetic or nerve block. The surgery typically takes anywhere between from 1-4 hours depending on the complexity of the operation required, especially when the disease intimately involves important nerves and blood vessels. Almost all patients have the surgery as day cases and go home after a short stay in recovery.
Hand therapy is important in recovering movement and function, especially for more extensive surgery and skin grafts. The recovery is as variable as the surgery, with regard to the degree of improvement achieved and the time to achieve the final position.
The outcome of the surgery is not always predictable and is dependent on many factors. These include disease severity and the complexity of surgery thus required, if the disease is recurrent, and the post operative course including complications, and compliance with hand therapy. The latter is critical in avoiding long term stiffness from surgery.
Dupuytrens surgery is generally safe. However, like all surgery, there are potential risks of complication. Generic risks include pain, bleeding, infection, or wound healing problems (higher chance if skin grafts are needed). The nerves and arteries that supply the finger can be injured. Technical factors may mean that the contracture cannot be fully released or the disease fully removed. Finally, surgery cannot influence genetics, and so there is always a risk that the Dupuytrens returns, either in the same position or elsewhere.
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Disclaimer: This website is intended to provide you with general information only. This information is not a substitute for advice from your Specialist Plastic Surgeon and does not contain all the known facts about this procedure or every possible side effect of surgery. It is important that you speak to your surgeon before deciding to undergo surgery. If you are not sure about the benefits, risks and limitations of treatment, or anything else relating to your procedure, ask your surgeon to explain. Patient information provided as part of this website is evidence-based, and sourced from a range of reputable information providers including the American Society of Plastic Surgeons, Better Health Channel and Mi-tec medical publishing.
