DUPUYTREN’S DISEASE
Reparative surgery:
This document has been conceived under the authority of the French Society of Plastic Reconstructive and Aesthetic Surgery (SOFCPRE).
DEFINITION, AIMS AND PRINCIPLES
Guillaume Dupuytren was a French surgeon who lived around 1800. He gave his name to this disease that affects the hand aponeuroses.
The aponeuroses are tissues situated between the skin surface and the underlying structures such as muscles, nerves and blood vessels.
They protect from trauma.
In some people, these tissues becomes bulky, ball-shaped, then called nodules, with extensions that retract the fingers from the palm of the hand and form true strings that gradually retract the fingers.
The opening of the fingers in extension is limited while the closure remains normal because the tendons are healthy.
In the advanced form, the fingers are locked in the palm of the hand.
The 4th and 5th fingers are most frequently affected but the disease can affect all fingers and is also present as nodules on the dorsum of the middle joints.
Problems of sensitivity and pain may occur if the thickenings of the aponeuroses compress the digital nerves.
A genetic factor is certainly at the origin of the disease, explaining that other family members can present with different forms.
The average age is fifty. This disease is more frequent in men than in women. As the disease appears earlier, is more aggressive and growing rapidly.
This thickening of the aponeuroses may also appears at the soles of the feet (Ledderhose’s disease) and in men in the penis (Peyronie's disease).
It has not been found any causal link between manual labour and Dupuytren’s contracture.
However, trauma may lead to its appearance and aggravation.
For now, we are not aware of other treatment for this disease apart from surgery, which involves removing the thickening of the aponeuroses in the palm of the hand and retracted fingers.
BEFORE THE OPERATION
Because this disease is not dangerous, the debutante mild forms are generally subjected to surveillance without treatment.
The intervention is proposed when a functional impairment occurs.
A pre-operative assessment is achieved in accordance with the usual requirements.
The anaesthetist will see for consultation at least 48 hours before surgery.
No medication containing aspirin shall be taken within 10 days preceding the intervention.
Stop smoking is strongly recommended before surgery.
It is essential to fasting (do not eat or drink) 6 hours before surgery.
TYPES OF ANAESTHESIA AND HOSPITAL STAY
The procedure is most often done under anaesthesia of the arm and requires no hospitalization except special needs.
THE PROCEDURE
Rarely, sections of retractile cords by a needle under local anaesthesia can be done.
More often, surgical intervention with opening of the skin is necessary and various techniques are proposed, each surgeon has his/her preference.
A technique called open palm consist in not to close certain surgical wounds.
There is nothing to be concerned about that technique; this is not an oversight by the surgeon or a premature disappearance of sutures.
In certain exceptional situations, we may have to perform skin grafts or flaps to close large skin losses occasioned by multiple resections.
Again, your surgeon will speak to you before surgery.
AFTER THE OPERATION: POSTOPERATIVE CARE AND FOLLOW-UP
The spontaneous healing is obtained in two to three weeks by changing the dressings as advised by your surgeon.
The average recovery after this type of intervention is one month.
After surgery, when the retraction is old or severe, it is sometimes suggested to wear a dental appliance, that is to say, an appliance that is customized to firm upon the operated finger. It is your surgeon who may prescribe it from an orthotist with whom he usually works.
The recovery of mobility is not systematic after long-term stiff joints, because the retraction may yield a non-recoverable stiffness in post-operative.
As after any intervention of the hand, it may appear algodystrophy, that manifest as painful swelling and stiffness of the fingers necessitating a quick consultation with your surgeon for his referral to physiotherapy and adequate medical treatment.
POSSIBLE COMPLICATIONS
-
The usual complications of surgery are haematoma, infection and skin necrosis that can extend the duration of healing.
-
One rare complication is the section of a digital nerve during surgery, leaving an insensitive area over a part of the finger that often diminishes with time but may also leave a painful sequela.
Your surgeon will advise you if any of this complication occurs.
-
Recurrences and extensions of the disease are not uncommon and some patients are operated several times in both hands.
-
Finally, in multi- operated fingers after many recurrences, the option of an amputation is sometimes contemplated.
Feel free to ask any questions to your surgeon, who is the best indicated to answer them.
All things considered, the risks must not be overestimated, but you must be conscious that an operation, even a minor one, always has some degree of unforeseeable unknown factors.
You can be assured that if you are operated on by a qualified Plastic Surgeon, he will have the experience and skill required to avoid these complications, or to treat them successfully if necessary.
These are the facts that we wish to bring to your attention, to complement what you were told during the consultation.
Our advice is for you to keep this document and to read it and think it over carefully after your consultation.
Once you have done this you will perhaps have further queries, or require additional information.
We are at your disposal should you wish to ask questions during your next consultation, or by telephone, or even on the day of the operation, when we will meet in any case, before the anaesthesia.
"Copyright", © "All Rights Reserved" SOFCPRE, any reproduction, even partial, of these texts is prohibited without permission from the French Society of Plastic Reconstructive and Aesthetic Surgery. A copy or reproduction by any means whatsoever, including photocopying, photography, screen capture, copy, paste, recording or otherwise, constitutes an infringement punishable under the Act of March 11, 1957 on the protection of copyright.
Authorization for reproduction of March 10, 2009, for: MCEI (www.chirurgiens-plasticiens.info).
This factsheet has been designed under the auspices of the French Society of Plastic Reconstructive and Aesthetic Surgery (SOF.CPRE) as a complement to your first consultation; to try to answer any questions you can ask yourself if you intend to use a surgical lipo-filling.
The purpose of this paper is to bring you all the information necessary and essential for you to make your decision with full knowledge of the facts. So is it advisable to read with the greatest attention.