Dupuytren Disease
Dupuytren disease is a condition affecting the connective tissue in the palm and fingers, starting with painless nodules and gradually advancing as retractile cords that cause progressive bending of the fingers into the palm.
WHAT IS DUPUYTREN DISEASE?
Palmar contracture, with flexion retraction especially of the fingers, is a degenerative disease of the palmar aponeurosis, a fibrous anatomical structure that covers the tendons and vascular-nervous elements of the hand.
The palmar aponeurosis changes through the appearance of nodules and fibrous cords that pull the fingers into flexion.
WHO CAN BE AFFECTED BY DUPUYTREN DISEASE?
It is a condition more common in men over 50, and in some cases, genetic factors are responsible for its occurrence.
The progression is slow, in episodes, over the years, with the hand losing its ability to extend the fingers.
RISK FACTORS FOR DUPUYTREN DISEASE
- age over 50
- male sex
- family history
- smoking and alcohol consumption
- diabetes
WHAT ARE THE COMPLICATIONS OF DUPUYTREN DISEASE?
Although the disease generally does not affect the thumb and index finger, for the other fingers the disease progresses, impairing normal function:
- inability to grasp large objects
- inability to extend the fingers
- joint stiffness
- fungal infections of the skin between the fingers
CAUSE OF THE DISEASE
Although in some cases hereditary factors are responsible for the appearance of Dupuytren contracture, in most cases the etiology of the disease is unknown. In some situations, the disease is associated with contracture in the plantar region of the foot (Ledderhose Disease) or penis (Peyronie’s Disease).
SURGICAL TREATMENT
Surgical treatment represents the best therapeutic solution. It is performed on an outpatient basis under local or regional anesthesia, with a hemostatic band, followed by an incision on the palmar side of the hand, meticulous removal of the affected palmar aponeurosis, then suturing the skin, dressing the affected area, and immobilization with a splint. Removal of the aponeurosis is a laborious operation, as the fibrous cords often surround the vessels and digital nerves like a sleeve.
Postoperatively, the splint will be kept for approximately 18 days, after which it is removed along with the stitches. This period is necessary for the hand skin to heal.
On the first day, an analgesic is required, and for 5 days you will take oral antibiotics to prevent infection.
POSSIBLE COMPLICATIONS AFTER SURGERY
- one of the most common complications is the formation of local hematomas, which may cause partial skin necrosis or become infected.
- accidental injury of the vascular-nervous pedicle is possible during surgery
- algoneurodystrophic syndrome is more common in women (6%) when removing the splint at the beginning of the functional recovery period of the hand,
- and consists of persistent painful edema of the hand.
- local recurrence, although rare, is also one of the potential complications.
Postoperative recovery of hand function is gradual over the next 3-4 weeks, through passive and active finger mobilization exercises, and gradual resumption of daily activities without excessive physical effort.
