Dupuytren Surgery Treatment

What is Dupuytren Disease?

Dupuytren's disease is a hand deformity that is developed over the years, which results in the fibrous layer of connective tissue that lies just underneath the skin in the palm and fingers, called fascia, to thicken and tighten. As the fascia is developed into thick cords and contracts over time, the fingers are pulled in towards the palm, known as a Dupuytren's contracture, thus it is difficult to straighten the affected digits.  To a layman person, Dupuytren's disease is sometimes confused with the trigger finger, a condition that can result in the bent fingers, but is an entirely different process and as such a different surgery is needed, called the trigger finger surgery.

Benefits of Dupuytren’s Contracture Surgery

Dupuytren’s surgery can help in straightening the fingers and thus improving hand function, which was affected by Dupuytren’s contracture.

Symptoms leading to Dupuytren’s Contracture Surgery

A Dupuytren's contracture progresses very slowly, over a period of years, signs and symptoms of the condition may include: 

• Nodules: The patients may develop one or more small lumps, or nodule, in the palm of their hand. This nodule is fixed to the overlying skin. Initially, the nodules may feel tender but, this tenderness usually goes away with time. In some of the cases, there can be pitting or deep indentation of the skin near the nodule.
• Cords: The nodules may thicken and contract, which results in the formation of dense and tough cords of tissue beneath the skin. These cords can restrict the fingers and thumb from straightening or from spreading apart.
• Contractures: As the tissue present under the skin tightens, one or more fingers may be pulled toward the palm and may be confined from spreading apart. The ring and little fingers are most affected, but either any or all of the fingers can be involved, even the thumb. Most commonly, the knuckle joint of the finger is affected, but the other joints may also be involved.

As the bend in the finger increases, it may become very difficult to straighten it fully. It may be difficult to hold large objects, and performing simple activities may not be that simple.

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What Complications Can happen?

Complications that may occur in the early stages:

• Hematoma: Tourniquet release and meticulous hemostasis before the wound is closed are highly recommended.
• Skin loss: Skin flaps can fail for a number of reasons, but the underlying hematoma is a bigger problem.
• Infection: Infection is followed by hematoma, skin loss, or both. If contracture restricts adequate skin preparation, a fasciotomy can be done as a preliminary measure before definitive fasciectomy.
• Division of digital nerve or artery: Dissection in a fasciectomy is very close to neurolysis; i.e., the involved neurovascular bundles must be dissected free along the entire course of the surgical wound. The greatest risk occurs at the area adjacent to the web space over the base of the proximal phalanx
• Loss of flexion range: This complication occurs at a later stage. Active and passive preoperative ROM must be recorded. Active flexion exercises must be a part of the early postoperative care. Maintenance of flexion range is generally neglected in the effort to regain full extension.
• Other postoperative pain: Local hyperalgesia is possibly due to digital nerve injury and neuroma formation, this can be very problematic. 
• Recurrence: Recurrence and recurrence of flexion deformity with disease extension are said to be separate units. A young patient with a strong family history and knuckle pads have more chances to have the recurrence.  

Cause

The cause of Dupuytren's disease is still not completely known, but the most evidence points towards genetics as having the most factors that play an important role.

There are a number of factors that contribute to the development or worsening of Dupuytren's disease.

These include the following:

• Gender: Men have more tendencies to develop this condition as compared to women.
• Ancestry: People of northern European and Scandinavian ancestry are believed to develop this condition.
• Heredity: Dupuytren's generally runs in families.
• Alcohol use: Drinking alcohol may result in Dupuytren disease.
• Certain medical conditions: People with diabetes and seizure disorders have more chances to have Dupuytren's.
• Age: This condition is more likely devolved in people of older age.

Procedure for Treating Dupuytren’s Contracture

Dupuytren's contracture surgery divides or removes the tissue in the palm that is thickened and digits with the aim to treat Dupuytren’s disease. The operation can be performed using different methods depending on the need of the patients.

Surgical options include:

Open or needle fasciotomy:  Usually an outpatient procedure is done under local anaesthetic. A sharp blade or a very fine needle is inserted into the fibrous bands of the patient’s palm or fingers for dividing the thickened connective tissue and thus releasing the tightness in the hand which was causing the contracture; The recurrence rate for needle fasciotomy is high.

Dupuytren’s fasciectomy: Usually this procedure is done under general anaesthetic as an outpatient procedure. A cut is made in the hand and the affected connective tissue is removed. A skin graft is needed to seal the wound. Fasciectomy is used for treating more severe cases. It is more effective than fasciotomy in the long term but has more risks with it.  

The main types of fasciectomy include:

• Segmental: Short segments of the cord are removed with the help of one or more small incisions.
•  Regional: Entire cord is removed with the help of a single longer incision.
• DermoFasciectomy: Cord and overlying skin is removed and requires a skin graft.

How soon will I recover?

• Severe problems are uncommon after the surgery, but the patients may experience some pain, swelling, and stiffness. 
• The goal of surgery is to improve digital straightening; however, some patients can lose flexion of the involved digits because of the stiffness. 
• Elevating the hand above the heart and gently moving the fingers is very useful in decreasing the swelling and also improving stiffness. 
• Physical therapy is useful in improving the strength and functioning of the fingers and hand, reducing swelling. 
• Often, a splint would be worn by the patients during their recovery.

Dupuytren’s Contracture Non-Surgical Treatment

Many patients opt for conservative treatment and this can be good in early stages of Dupuytren’s contracture, but often may not be a cure. In more severe cases, surgery may be required at some point of time in the future. The purpose of non- surgical procedures is to provide symptom relief, preservation of hand dexterity as well as to retard the course of the disease. It may be possible to experience the symptoms again and most likely the long treatment process may take longer with use of some therapies. Dupuytren’s Contracture Non-Surgical Treatments are Stretching and Physical therapy for Finger Contracture Release, Steroid Injections and Enzyme Injections for Dupuytren’s contracture.

Best Hospitals for Dupuytren’s Contracture Release Surgery

• Artemis Hospital, Gurgaon
• Medanta The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket
• BLK-Max Super Speciality Hospital, New Delhi

Best Doctors for Dupuytren’s Contracture Release Surgery

• Dr. Ramkinkar Jha
• Dr. Raman Kant Aggarwal
• Dr. Subhash Jangid
• Dr. Vikas Gupta
• Dr. Puneet Girdhar

Why Choose GetWellGo for Dupuytren Surgery? 

GetWellGo is a healthcare service provider, which provides services for Dupuytren’s contracture surgery together with several other medical services. Here are some general reasons why people might choose a healthcare provider for Dupuytren's surgery:

• Expertise and Specialization
• Comprehensive Care
• Advanced Technology
• Language Support
• Visa Assistance
• Travel and Accommodation Services

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FAQ

1. What are the advantages of operating for this problem?

• Restores Finger Mobility: The principle objective of the surgery is to open the contracted tissue, increase pronation and supination of the fingers, and facilitate positioning of the hand in the straight position.
• Prevents Further Deformity: It may also reduce the likelihood of its development if surgery is done early enough and especially where the fingers are significantly bent.
• Improved Function: After some surgeries, for instance, there enhanced grip strength and the ability to hold objects in the hands.

2. What is the success of Dupuytren’s surgery?

This surgery employs different techniques, and therefore, the success rate depends on the technique employed, or type of Dupuytren’s Contracture.

In general:

• Fasciotomy and Fasciectomy are said to range between 70- 90% success rate concerning functional improvement and decrease in contracture. But, relapse is likely to occur if the condition is severe or if other underlying issues are responsible for the condition.
• Needle Aponeurotomy could have the advantage of a lower recurrence level but it is much less efficient in stage B and higher.
• Demands of Xiaflex injections range from 60-80% of the patients developing improvement in hand function as well as straightening of fingers.

3. How long does one take to recover after a Dupuytren’s surgery?

• Initial Recovery: You may require wearing a splint for a few days in order to guard the hand. Sometimes, it can cause pain and swelling, and though there are drugs you can take, the pain usually persists a while.
• Follow-up Care: Having difficulty in the movement is one of the symptoms that require a recommendation to apply for physical therapy. You might have to be using your hands in exercising quite often.
• Full Recovery: Recovery time also varies, though most patients start regaining functions and strength of the hand in about 3-6 months to normal after the surgery. It is said that some of these patients take a year or more to fully recover.
• Return to Work: If you do not have the job where you need to utilize your hands, you could come back within 1-2 weeks. If you use your hands extensively in your line of work such as dancing, acting or sports, you might take 4 to 6 weeks to recover fully.