Patient Information Leaflet : Dupuytren’s Disease

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What Is It?

Dupuytren’s disease 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. This is known as Dupuytren’s contracture.

How does Dupuytren’s contracture happen?

The reason why fibrous nodules and bands of tissue form is not fully understood. It used to be thought that the disease was caused by heavy manual work, but this is not the case.
Dupuytren’s contracture is more common in men than in women and it tends to run in families. It is sometimes associated with diabetes, liver disease or smoking. However, most sufferers have no particular risk factors. If one or more fingers develop contractures which interfere with hand function, your surgeon may recommend an operation.

What will happen if I decide not to have the operation?

Although surgery is not essential, Dupuytren’s 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. Sometimes the only option for a stiff and contracted finger is amputation.

What does the operation Involve?

You should remove any rings from your hand before you come into hospital. 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 Dupuytren’s 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 of the affected skin and replacing it with skin grafts. Usually the operation will be carried out under a general anaesthetic.
At the end of the operation, your surgeon will close the skin with stitches. Your hand will be put into a heavy bandage.

General Complications (of any operation)

Pain : which happens with every operation. You will have local anaesthetic injected into your hand during the operation to help relieve any pain you may feel after the operation. The healthcare team will also give you painkillers if you need them.
Bleeding : after surgery. This is less likely if you keep your hand raised up.
Infection in the surgical wound :
This is not uncommon but may occasionally need antibiotics.
Scarring : This will be tender and inflamed for six weeks and need frequent massage for three-six months using moisturiser cream or Bio-oil.

Specific complications of this operation

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 rare.
Incomplete Correction of the Dupuytren’s contracture due to loss of movement of the finger joints. Your surgeon will let you know before the operation how much correction you can expert from surgery.
Numbness in the fingers operated on. The small nerves in the fingers often pass near or even through the fibrous Dupuytren’s 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 wounds can be quite moist and sticky for a couple of weeks after the operation. Sometimes a small area of skin dies (there is a risk of 1 in 25). 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 up in a sling or on a pillow next to you when you are in bed. You should be able to go home later on 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 will require the bandage for four-five days and removal of your stitches 8 – 10 days following your operation. You will not be able to drive for at least two weeks and will be off work for up to six weeks. You will have sensitive scarring for around six months.

Returning to normal activities

Mr Varley or your physiotherapist will tell you when you can return to normal activities. Physiotherapy is not given routinely but weekly attendances with a hand therapist for the first six weeks would be helpful. You will have an outpatient appointment to check that the wounds are healing satisfactorily. 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.

The Future

It can take some time for your hand to settle down after surgery. Slight stiffness of the finger joints is fairly common. The scars can be fairly thick at first but will gradually become less obvious.
Dupuytren’s 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.