Surgical Treatment of Dupuytren’s Contracture
- Are you just beginning to explore treatment options for your Dupuytren’s contracture? Perhaps your general practitioner referred you here? You’ve come to the right place! With our help, you will receive comprehensive information about the surgical treatment of your Dupuytren’s contracture.
Dupuytren’s Contracture
Dupuytren’s contracture is a condition in which the finger(s) bend inward. This flexion is caused by thickening and shortening of the fibrous bands that anchor the skin of the palm to the underlying strong connective tissue membrane, which also affects the position of the fingers. This contracture / joint stiffness makes it difficult to perform everyday activities such as driving, shaking hands, playing sports, and holding objects.
The disease was first described in 1831 by Guillaume Dupuytren, Napoleon Bonaparte’s physician.
Dr. György Kocsis PhD
Orthopedic-Traumatologist, Chief Hand Surgeon, University Assistant Professor, Wrist, Elbow, and Shoulder Surgeon, Upper Extremity Specialist
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Anatomy of the Palm
In the palm, beneath the skin, a connective tissue membrane stretches out, protecting the underlying nerves, blood vessels, and tendons. The disease and contraction of this connective tissue membrane is Dupuytren’s contracture, which typically affects the ring and little fingers, but can occur in other digits as well.
Initially, the disease manifests as scarred and hard nodules in the palm, later developing into hard, cord-like bands extending toward the fingers. As a result, the finger begins to bend into the palm and the patient can no longer fully extend it.
These nodules initially do not cause symptoms, only triggering tenderness when gripping. Later, extension of the affected fingers becomes limited. In the final stage, the fingers become fixed in a bent, forced position.
Causes of Dupuytren’s Contracture
Dupuytren’s contracture is fundamentally classified among genetic diseases, with familial clustering being common. Furthermore:
- It is often associated with diabetes, and this condition affects far more men than women.
- It occurs more frequently in Northern European countries than in Southern European ones, which is why some call it Viking disease.
- The disease is painless, so many people seek medical attention at an advanced stage. In such cases, palmar contracture causes not only aesthetic disturbance, but the bent fingers may interfere with the patient in:
- Work
- Driving
- Handshaking
- Wearing gloves
- Personal hygiene
- It often appears in both hands.
Surgical treatment of Dupuytren’s contracture is indicated when cord formation appears, or when the patient cannot fully extend their finger or fingers. The smaller the loss of motion, the better the expected outcome following surgery. If the fingers are already pressed into the palm, surgical treatment is much more difficult, the risk of potential complications may increase, and the patient can expect lengthy post-operative care.
The Dupuytren’s Contracture Surgery Procedure
The operating surgeon exposes and removes the contracted palmar fascial band through a so-called zigzag incision extending from the palm to the finger. Through this removal and mobilization of the joints, extension of the finger or fingers is made possible.
We use a bloodless field, which ensures that bleeding from the wound does not interfere with the surgeon’s work. For the bloodless field, we first wrap an elastic bandage around the affected forearm, thereby emptying the blood from the veins. Then we place a cuff—similar to that of a blood pressure monitor—on the upper arm, which we pressurize, temporarily stopping circulation to the limb. At the end of the surgery, blood accumulating in the wound is drained through a plastic tube from the surgical site.
The surgery is performed under general anesthesia or axillary nerve block, so the patient will not find the tourniquet cuff on their upper arm uncomfortable, which allows for easier execution and shorter surgical time.
Depending on the extent of the disease, we can use various skin incisions, and we remove the contracted tendinous sheet as completely as possible.
During surgery, we also take into account any previous surgery performed for similar reasons and the resulting scars.
Suitability for Surgery
The surgeon performing your operation will review your medical history and conduct a thorough physical examination.
Diagnosis of Dupuytren’s contracture is primarily based on physical examination (visual inspection of the hand, palpation, and measurement of joint range of motion).
We recommend surgery if the flexion of the fingers is such that you are already experiencing significant deterioration in quality of life, with symptoms preventing:
- Daily activities
- Work
- Driving
- Sports
- Sports
- Hobbies
- Handshaking
- Wearing gloves
- Cooking and even
- Personal hygiene
Attila Bereczki’s Recovery Story
Our hand specialists
Dr. György Kocsis PhD
Orthopedic-Traumatologist, Chief Hand Surgeon, University Assistant Professor, Wrist, Elbow, and Shoulder Surgeon, Upper Extremity Specialist
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