What is Dupuytren’s contracture
In the palm of the hand, there is a three-dimensional fibrous structure whose function is to anchor the skin of the palm to the underlying skeleton. This ‘palmar fascia’ prevents the skin sliding about when the hand grips an object. Elsewhere in the body, the skin is freely mobile.
Dupuytren’s disease is a contracture of this palmar fascia. The reason for this contracture is unknown but it can run in families especially of Northern European origin. The condition sometimes occurs after trauma or surgery and is slightly associated with diabetes, smoking and alcohol consumption, although most sufferers have none of these risk factors.
Dupuytren’s is not usually painful, but it can be extremely debilitating. In its early stages, it presents with lumps and pits in the skin of the palm. Bands of fibrous tissue develop within the fascia and as they tighten and contract, the fingers may be forced to flex and curl up. The speed with which this happens varies. Surgery is generally of benefit if the palm can no longer be laid flat on the table but constraints on NHS funding may require greater deformity to be established.
What treatment is available
The aim of surgical treatment is to remove diseased fascia and skin and to allow straightening of the fingers before permanent deformity develops. Some cases can be treated with a simple division of a fibrous cord using a needle, and this can be done in the outpatient clinic. In mild cases requiring surgery, all that might be needed is the removal of a small section of the diseased fascia. In severe cases, skin grafts may be required, and if joints have been bent for prolonged periods, then the ligaments to those joints might need to be released to allow straightening. Sometimes it is not possible to fully correct the deformity
The progress of Dupuytren’s contracture cannot be cured but, by removing the affected tissue, the fingers can be straightened and function restored. Depending upon the individual rate of progress, the disease will eventually recur and half of patients require surgery again within five years.
