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DUPUYTRENS CONTRACTURE
What is Dupuytrens Contracture?
Dupuytrens Contracture is a condition where scar-like tissue forms just beneath the skin of the fingers and the palm of the hand. Over time this fibrous tissue can contract and force one or more fingers to curl up into the palm.
What will happen if I decide not to have the operation?
Although surgery is not essential, Dupuytrens contracture does not get better without it. The condition will often get slowly worse with time and can result in one or more fingers being held bent into the palm.
If this is left untreated, your finger joints may become permanently stiff and an operation at this stage is less likely to be a success.
What does the operation involve?
Your surgeon will let you know before the operation how much correction you can expect from surgery.
You should remove any rings from your hand before you come to the Surgery. Your surgeon will discuss with you before the operation how much surgery you are likely to need. This depends on the position and severity of the Dupuytrens contracture, the condition of the skin and if you have had any previous surgery. The surgery can range from simply cutting a fibrous band in the palm of your hand to removing all the affected skin and replacing it with skin grafts.
Usually, the operation will be carried out under a local anaesthetic. At the end of the operation, your surgeon will close the skin with stitches. Your hand will be put into a heavy bandage.
Complications of this surgery:
Scarring
The wound may be tender and inflamed for up to 6 weeks, frequent massaging with non perfumed moisturiser (E45) or Bio Oil will help.
Injury to the small arteries in a finger
If both the main arteries to a finger get damaged, you may lose the finger. This is extremely rare.
Numbness in the fingers operated on
The small nerves in the fingers often pass near or even through the fibrous Dupuytrens tissue so some damage to the nerves is possible (there is a risk of 1 in 100). This usually improves with time, but you may not completely recover normal feeling. Your fingers may also be sensitive to cold.
Wound healing problems
The wound can take up to 6 weeks or more after the operation to heal. Sometimes a small area of skin dies (there is a risk of 1 in 20). This is not usually a cause for concern and the wounds generally heal well.
Severe pain, stiffness, and loss of use of the hand (Complex Regional Pain Syndrome)
This is rare and the cause is not known. If this happens, you may need further treatment including painkillers and physiotherapy. The hand can take months or years to get better.
How soon will I recover?
After the operation you will be transferred to the recovery area. You will need to keep your hand lifted in a sling. You will be able to go home later the same day. A responsible adult should take you home in a car or taxi and stay with you for at least 24 hours. You will need support for a few days.
At home
You be will required to wear the bandage until the removal of your stitches 12-14 days following your operation. You will have sensitive scarring for around six months.
Returning to normal activities
In 4 – 6 weeks you should be able to return to work depending on how well your scar has healed.
Regular exercise should help you to return to normal activities as soon as possible. The recovery time varies according to the extent of your surgery. Do not drive until you are confident about controlling your vehicle and always check with your doctor and insurance company first.
If you feel a stiffness in the finger, please visit your GP as you may require physiotherapy.
The Future
It can take some time for your hand to settle down after surgery. Slight stiffness of the finger joints is common. The scars can be thick at first but will gradually become less obvious.
Dupuytrens disease will probably come back in most people eventually but will not always need further surgery. This is usually due to new fibrous bands and nodules forming.