Surgical and nonsurgical treatments of Dupuytren’s disease help improve motion in the affected fingers and slow down disease progression.
Dupuytren’s disease is a condition of the palmar fascia, a sheath of connective tissue found just underneath the skin that protects underlying structures, like the tendons, muscles, nerves and blood vessels.
The condition causes the palmar fascia to thicken and contract, pulling the fingers inward. As the disease progresses, it becomes increasingly difficult to fully straighten the fingers. This is then referred to as “Dupuytren’s contracture.”
We don’t know what causes Dupuytren’s disease, but there seems to be a genetic link. The condition is more likely to affect older men, those with a family history, people with diabetes, those who smoke tobacco and drink alcohol, and people of Northern European ancestry.
Symptoms of Dupuytren’s disease become worse as the disease progresses over months and years:
Early in the disease, one or more small lumps form on the palms, usually at the base of the fingers. Dents and pitting often form around these nodules. The nodules initially feel tender, which tends to improve over time.
As the condition progresses, the nodules thicken and contract, forming long cords in the fascia. These cords cause the fingers to pull toward the palm.
The most advanced symptom of Dupuytren’s disease is contracture. The cords become tight and constrict, making it impossible to straighten the fingers.
The ring and pinky fingers are usually affected by Dupuytren’s disease, but any finger can be involved.
There is currently no cure for Dupuytren’s disease. Treatment aims to improve symptoms and slow down disease progression. Initially, most patients can be treated with conservative and nonsurgical approaches because the condition tends to develop slowly over many years.
The effectiveness of these treatments varies from patient to patient, and some can lead to complications and side effects. Recurrence rates are often high with these treatments.
Another minimally invasive treatment for Dupuytren’s disease is collagenase injections. Plastic Surgery Austin is proud to be the first clinic in Austin, TX, to use this treatment for Dupuytren’s disease. Collagenase injections lead to significant improvement in contractures, and do so without the associated downtime required for surgery.
At Plastic Surgery Austin, we use Xiaflex®, the first and only FDA-approved collagenase injection for adults with Dupuytren’s contracture. It contains an enzyme produced by the bacterium Clostridium histolyticum, which breaks down collagen fibers in Dupuytren’s cords. This helps weaken the cord without affecting surrounding tissue.
This in-office treatment can be performed without anesthesia and requires one to four treatments. For this treatment, your doctor first injects this prescription medicine into Dupuytren’s cords and then manipulates your fingers at a separate visit to rupture the cords.
Although very effective for isolated single cords and finger contractures, there is a recurrence rate that is dependent on several factors. It is best to discuss your particular circumstance and determine if collagenase treatment is right for you.
Surgery is usually recommended for patients with advanced Dupuytren’s disease for whom the condition interferes with hand function. Two surgical techniques are used to decrease the contracture and restore hand function:
Using a local anesthetic, your surgeon makes a skin puncture in your palm and sections/releases the thickened cords of the fascia — usually requiring multiple passes to manipulate and stretch out the fibrous tissue.
Making zig-zag incisions, your surgeon removes as much abnormal fascia tissue as possible to help straighten the fingers. This tends to be the most complete method of removal and, in Dr. Sharma’s hands, the most effective.
Dupuytren’s disease surgery is an outpatient procedure. Most patients only need to wear a splint for the first week of their recovery and are referred to occupational therapy to improve the scarring, range of motion and function of their hands. The typical healing is over three months, but patients are using their hands generally pain-free from two weeks after surgery.
Surgery is the mainstay treatment for Dupuytren’s disease. Ideal candidates for this procedure are those who:
We will provide you with pre-op instructions before your scheduled surgery. Preparation for this procedure usually involves:
Dupuytren’s contracture surgery is an outpatient procedure, usually performed under general anesthesia. This means you will go home on the day of your surgery and will be awake during the procedure.
Dr. Sharma will first administer medicine to numb your hand. He will then make an incision in your palm and cut or remove the thickened fascia. The incision is then closed with sutures. Your hand will be wrapped in bandages and placed in a splint that you will need to wear during your recovery.
At home, you will need to keep your hand clean and dry and wear your splint as prescribed. It is recommended to keep the hand elevated above heart level to minimize swelling. We will advise you on how to manage pain with prescription or over-the-counter pain relievers.
Incision, suture removal and range of motion will be handled by the Occupational Therapist starting one to two weeks post-surgery. They will help with edema control, tendon gliding and scar management for the duration of healing. Visits to the OT usually take place one to two times per week.
Initial recovery from Dupuytren’s contracture surgery takes about six weeks. It may take several months for you to regain full strength and range of motion in your hand and fingers.
Dupuytren’s disease has a slow progression over months to years. About one in five sufferers will develop contracture 10 years after their symptoms begin.
All treatments offered to patients with Dupuytren’s disease improve hand functioning and slow down disease progression; however, the disease does tend to recur in many patients.
If your job does not involve using your hands, you may be able to resume work within a week or two after surgery. Otherwise, you may need to wait up to 6 weeks or until your hand has fully healed.
Like nearly all medications, collagenase injections can cause side effects. These may include bruising, swelling, redness, itching and pain.
Complications following surgery for Dupuytren’s contracture are rare but may include severe pain, scarring, infection, and nerve or blood vessel damage.
Dupuytren’s disease, while not life-threatening, can make it difficult to perform simple tasks, like using your keys or holding a beverage can. At Plastic Surgery Austin, we offer surgical and nonsurgical treatments for Dupuytren’s disease and contractures.
Contact Plastic Surgery Austin today to schedule a consultation with Dr. Sharma. He will help you decide on the best course of treatment so that you can recover your full range of motion with minimal risk of complications.
Call us at 512-838-3658 or connect with us online now!
Contact our office to schedule a private consultation with Board Certified Plastic Surgeon, Sanjay K. Sharma, M.D., F.A.C.S.
