Dupuytren's Disease
Definition
This is a retraction of the anatomical subcutaneous tissue at the level of the palm of the hand or finger, called the palmar aponeurosis.
What are the causes?
There is no specific cause. A genetic background may exist, with familial forms; in such cases, it is common to find identical symptoms in a first or second-degree relative.
What are the symptoms?
At the early stage, this retraction may produce nodules or hardened cords (called bridles) under the skin. In more advanced stages, this retraction leads to a more or less significant retraction of the finger.
The condition may also affect other parts of the body, particularly on the sole of the foot (Ledderhose disease), or on the penis causing angulation during erection (Peyronie's disease). Finally, swellings of the joints on the dorsal side of the fingers, called «knuckle pads», may exist in some forms.
What tests may be requested?
Diagnosis is clinical, no test is needed.
How is this condition treated?
There is no therapy to prevent the progression of the disease, which cannot be cured. Only surgical treatment can slow its evolution but cannot prevent recurrence in the medium or long term, especially in aggressive forms. Surgical treatment is considered as soon as the finger begins to retract, or in early forms without digital retraction if the subcutaneous nodules or cords interfere with grip.
When Dupuytren's disease only affects the palm of the hand at an early stage, a needle aponeurotomy (cord-cutting needle procedure) may be offered, but with a high risk of recurrence.
In more advanced stages, so-called «open» surgery is considered. Local removal of the aponeurosis (called aponeurectomy) with dissection of all noble structures of the affected finger is performed.
In familial and/or early forms (<40 years) and/or with another location of the pathology, removal of the skin associated with a full-thickness skin graft (dermofasciectomy with full-thickness skin graft) is considered to limit recurrence, which is very common in these forms considered severe.
Recovery is marked by local care for 15 days and, when necessary, the wearing of a finger extension splint, particularly at night, combined with physiotherapy and self-rehabilitation maneuvers for at least one month.
What are the risks of the procedure?
Risks inherent to any surgery:
complex regional pain syndrome (formerly known as «algoneurodystrophic syndrome»): the hand becomes red, warm, swollen, and painful with persistent «electric» pain. This syndrome can last several months.
soft tissue infection
hematoma, which may resolve spontaneously or require surgical revision depending on its size.
Skin suffering or necrosis, especially in advanced forms and favored by postoperative hematomas.
Arterial or nerve injuries: higher risk in advanced forms with significant finger retraction and especially in revision surgeries in case of recurrence.