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Medically Reviewed April 2023, by Mr. Bryan Mayou (GMC: 1414396) - founder of the Cadogan Clinic and one of the world's leading plastic surgeons
Dupuytren's Contracture surgery is treatment designed to straighten the fingers which have been bent by this particular medical condition.
There are three different Dupuytren's Contracture treatment options - needle fasciotomy, fasciectomy and dermafasciectomy.
Needle fasciotomy involves inserting a needle into several places along your palm and finger to loosen and straighten it. In a fasciectomy, the surgeon will make a cut along the length of the palm and finger in order to straighten it. Dermafasciectomy is similar to a fasciectomy, except an additional area of skin is removed from the treatment area. As part of this procedure, a skin graft is taken from elsewhere in the body to replace the skin that has been removed.
There are pros and cons to each procedure. A dermafasciectomy involves two procedures (straightening the fingers and a skin graft) meaning it has a longer recovery time. In comparison, a needle fasciotomy is considerably less invasive and you can expect to have recovered within two weeks. But the dermafasciectomy and fasciectomy procedures have the lowest risk of Dupuytren's Contracture returning.
These procedures will be discussed at length with your surgeon who will decide the best course of action.
Dupuytren's contracture is a condition that causes a thickening of the deep tissue that passes from the palm to the fingers. This thickening means the tissue is less flexible.
Symptoms usually start as a small nodule or pit in the palm of the hand, which can then develop into cords of tissue that pull the fingers back towards the palm (the contracture).
As it progresses, Dupuytren's contracture can cause one or more fingers to bend in towards your palm.
It mainly affects the ring and little fingers, but any of your fingers or thumbs may display the symptoms of the Dupuytren’s. You can experience symptoms in both hands at the same time.
The condition progresses slowly over many months or years. There is no cure for the condition but in severe cases Dupuytren's surgery can straighten the affected fingers. Treatment may not help in the early stages of the condition. Not all patients will develop contractures and some may be monitored only.
Words from our clients:
"I was extremely satisfied with the care and treatment I received at the Cadogan Clinic. My surgeon was friendly and informative and explained the procedure fully. My procedure went very well and with the excellent care of the nursing staff, I made a speedy and full recovery. Would recommend to anyone."Eva Berry
"At the beginning before the operation the nurse taking care of me made me feel so comfortable. The surgeon and anesthetist helped me feel so calm. Fantastic before and after treatment"Scarlett Elliott
"The girls on the reception at the clinic were very pleasant and professional. The nurse who took out my stitches after my surgery was just lovely and took me through step by step what she was doing and she also recommended a great cream to use to help with healing."Georgina Nolan
“I was treated with care and provided with thorough knowledge about the procedure I was undertaking. My surgeon was very methodical (a perfectionist) and I felt I received A class treatment."Courtney O'Sullivan
"Outstanding experience from the first appointment to being discharged. Very professional, friendly and a fantastic outcome."Gemma Stevenson
"Reception staff very welcoming and efficient. Both nurses who I dealt with were fantastic, and the whole team (anaesthetist, surgeon etc) were friendly but professional, and really put my mind at ease. That I was able to stay later than I perhaps needed after my surgery to fit in with my husbands schedule was greatly appreciated."Emma Davies
It is not known exactly what causes Dupuytren's Contracture to develop, but it is believed that the condition may run in families. There is evidence to suggest that the condition may also be linked to nutritional deficiencies, diabetes and certain medications used to treat epileptic seizures.
The condition has also been linked to excessive alcohol intake and smoking. This is believed to be down to the microscopic changes within the blood vessels caused by smoking.
There is a certain demographic which is considered to be at a higher risk of developing Dupuytren's Contracture. The condition usually starts in middle age and is more common in men than women. You are also at a higher risk of developing Dupuytren’s Contracture if you have a Scandinavian or Northern European background. The condition is most commonly found in people whose families come from these regions.
At this current time, there is no evidence to suggest that Dupuytren's Contracture is caused by hand injuries. People who work in occupations that involve vibrations to the hands, such as construction work, are not believed to be at an increased risk of developing the condition.
It is not known whether Dupuytren's Contracture can be prevented or if you can stop it from coming back permanently. Dupuytren’s Contracture does not go away on its own.
The first sign of Dupuytren’s Contracture is the appearance of dimples or ridges on the palm of the hand. A firm lump of tissue can appear on the palm. You may find this sensitive to touch, but it is not normally painful. This can then develop into cords of tissue that pull the fingers back towards the palm. Eventually your finger may get stuck in a bent position as the condition progresses.
As the condition progresses, you may find that you cannot put your hand down flat on a table and you may find yourself having difficulty performing your normal day-to-day activities. People with advanced Dupuytren’s Contracture find they struggle to grasp large objects, fully open their hands and put their hand into narrow spaces.
Although the condition can potentially affect any finger, it is much rarer for it to affect the thumb and index finger. Since these are not usually affected, Dupuytren’s sufferers find that the condition does not interfere with their ability to carry out fine motor activities, such as writing.
Because of the nature of the condition, the diagnosis process for Dupuytren's Contracture is quite straightforward.
The surgeon will examine the finger or fingers concerned and compare your hands to each other. They will also check for puckering of the skin on the palms and press on various parts of the hands and fingers. This is to check for tough knots or bands of tissue. You will be asked to put your hand flat on a flat surface. They will also ask you questions about your symptoms.
Diagnostic imaging, such as an MRI or ultrasound, are usually not required.
Dupuytren's Contracture surgery is recommended in cases where the disease has progressed to the level that it is interfering with your ability to carry out basic day-to-day tasks. Surgery is the most effective Dupuytren's Contracture treatment. Dupuytren’s surgery sees the affected tissue surgically removed from the palm of the hand. If the condition is particularly severe, the surgeon may remove this tissue and any other tissue likely to be affected by Dupuytren’s, including the attached skin. If this is the case then a skin graft will be required to cover the wound. It is a more invasive procedure with a longer recovery time attached. You will need physical therapy afterwards.
Alternatively, a needle can be used to puncture and break the cord of tissue which is causing the finger to bend. Although this method is considerably less invasive as there is no incision required, the contractures can reoccur. This procedure also can’t be used in some places on the hand because there is a risk of tendon or nerve damage. This method requires less physical therapy afterwards.
Your surgeon will discuss the various Dupuytren's Contracture surgery options available to you and decide which one is best to meet your needs.
We have invited a selection of the country's very best consultants to join us at the Cadogan Clinic so that you can be sure that whatever the nature of your treatment, you will be seeing one of the top practitioners in the country.
The Patient Journey. A breakdown of what you can expect on your journey with us
We are deeply invested in ensuring that every step of your surgical journey with us is as informative and reassuring to you as it can be. This article outlines what you can expect at each stage of the journeyThe Patient Journey
What is the best treatment for Dupuytren’s Contracture?
The best Dupuytren’s Contracture treatment is a fasciectomy and a dermafasciectomy. With these surgical treatments there is less chance of the Dupuytren’s Contracture returning than with a needle fasciotomy.
A fasciectomy is a quicker procedure than a dermafasciectomy as there is no need for a skin graft and as a result the recovery process is quicker and may involve less physical therapy afterwards. However a needle fasciotomy has an even faster recovery time.
Steroid injections are sometimes used to control any pain associated with the condition and in some cases may prevent Dupuytren’s Contracture from getting worse. But steroid injections are not able to right the damage caused by the condition.
Enzyme injections is a relatively new Dupuytren’s Contracture treatment and this involves injecting a certain type of enzyme directly into a taut cord, weakening and loosening it enough to allow a surgeon to manipulate the hand, break the cord and straighten the fingers. However there is a greater chance of Dupuytren’s Contracture returning with this type of treatment compared to Dupuytren’s surgery.
What happens if Dupuytren’s Contracture is left untreated?
This really depends on the severity of the Dupuytren’s Contracture. Some people find that their symptoms never progress beyond the early stages and can be managed with pain relief and finger-stretching exercises to maintain mobility. However, if advanced Dupuytren’s Contracture is left untreated, this can result in the affected fingers being pulled into the palm, leaving them permanently bent in position. This makes performing some day-to-day tasks extremely difficult, such as grasping large objects and fitting the hand through narrow spaces. This can ultimately impact on all areas of your life, preventing you from playing sports, enjoying hobbies, socialising, cleaning and, depending on the type of work you do, this can affect your employment.
Can I get Dupuytren's Contracture treatment on the NHS?
Yes, you can get Dupuytren's surgery on the NHS. However the NHS has been, and continues to be, hit hard by the Covid-19 pandemic. High levels of staff sickness has had an impact on waiting times across the board. These waiting times vary from hospital to hospital. You could potentially be facing weeks or even months of waiting for your Dupuytren's Contracture surgery on the NHS. And any new waves of Covid-19 infections may result in this wait getting even longer. Of course it is not the fault of the NHS, but if faced with a lengthy wait for treatment, you may find that your condition worsens. Because of this, many people choose to go to a private clinic for their Dupuytren's Contracture treatment. At the Cadogan Clinic, there is no waiting list, so providing you meet the criteria, you can have the procedure promptly.
Are there any home remedies for Dupuytren’s Contracture?
There are certain things you can do at home to prevent the condition from getting worse.
You should try to protect your hands where possible by wearing padded gloves when doing housework and when carrying out any tasks that involve heavy grasping. Avoid a tight grip on tools by using cushioned tape or pipe insulation on the handles. Try to avoid activities that involve repeated gripping or straining of the fingers wherever possible. You may also find that finger stretching exercises help.
As there are proven links between Dupuytren's Contracture and smoking and excessive drinking, it is advisable to quit smoking and cut your alcohol intake. Doing so will also have a positive impact on your overall health.
However, despite taking all these measures, your condition may still persist or get worse. Surgery is the only way to successfully treat Dupuytren's Contracture.
Is Dupuytren’s a form of arthritis?
Yes, Dupuytren’s is a form of arthritis. Arthritis refers to more than one hundred different conditions and some of these have wide-ranging symptoms and causes. It is important that arthritic conditions are diagnosed quickly so they can be treated appropriately.
Here at the Cadogan Clinic, there is no waiting list for Dupuytren's Contracture surgery and you will be able to have your procedure carried out as a day case at our award-winning London clinic. Book a consultation with one of our expert surgeons and find out how quickly we can relieve you of your Dupuytren's Contracture.
How long does it take to recover from Dupuytren’s Contracture surgery?
Recovery times are dependent on the severity of the condition and the type of surgery.
With a fasciectomy, it takes around two to three weeks for the area to heal, followed by another two to four weeks to overcome the postoperative stiffness with physical therapy. The most severe cases, including those patients who have had dermofasciectomy, can take up to three months to recover.
However a splint may be needed for many months after the operation to maintain the surgical correction of the finger(s). At first, it will be necessary to wear the splint night and day, but often this reduces to night-time only after about a fortnight once your stitches are removed. With a needle fasciotomy you can expect to have the full function of the hand restored within two weeks.
It is very important that you follow all the aftercare advice issued by your surgeon. Failure to do so may impact on your recovery and the final result.
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