Dupuytren’s disease is a morbidity of the firm connective tissue strands (skin fixation ligaments) on the inside of the hand. It may reach into the fingers (strands and nodules). The condition is named for Baron Guillaume Dupuytren (1777-1835). In 1832, Dupuytren described the surgical treatment of the condition named for him (palmar fibromatosis).
The cause for this condition is still unclear. It has been shown that it can be inherited, so that the condition may occur more frequently in some families. In addition, it also occurs with increased frequency in patients with diabetes mellitus and epilepsy treated with medicine. Men are affected five times more frequently than women.
In the beginning, most patients pay no attention to the condition. Pain is very rare. The condition begins with smaller nodules or strands in the palm, often across the rays of the pinky and the ring finger. The further course differs between individuals; contracture of the connective tissue strands often occurs. Ultimately, it becomes impossible to fully extend the affected finger(s). These malpositions can have a significant impact on movement in daily life, at work and during leisure activities.
3 forms of therapy are currently used:
Percutaneous needle fasciotomy (puncturing)
This procedure involves weakening the affected Dupuytren strand under local anaesthesia by multiple percutaneous punctuations with an injection needle, subsequently forcing it open by extending the finger. This technique works very well as an emergency measure, but the possibility of a reformation of the strand (recurrence rate) is increased. On the other hand, the rehabilitation time is shorter.
Injection therapy with collagenase (Xiapex®)
Collagenases are biologically active substances which dissolve connective tissue. The substance Xiapex® will locally dissolve the Dupuytren strand after injection. After an exposure time of 24 to 72 hours, the treated strand can be forced open by a targeted extension movement. The strand will rupture and the finger can be extended. Both injection and extension can be painful; this technique is therefore applied under local anaesthesia. Haematomas, blister formation and skin lacerations have been observed in some cases following treatment. These will usually heal within the following days, however. To secure the best possible outcome of treatment, a splint will be fitted to the affected hand. It is worn at night-time for four to six weeks.
Partial fasciectomy (separation of the strand)
This procedure involves the removal of all nodules and strands causing the limitation of extension capacity, either under local or general anaesthesia. The main complication for this technique is a risk of damage to vessels or nerves, particularly in case of very strong flexion of the proximal interphalangeal joint. The risk of this complication is significantly increased if the same finger has already undergone surgery in the past. Rehabilitation time is also increased in this case. For postsurgical care, the treated finger should be rested in a splint for the first six to eight weeks to prevent unfavourable scar formation.
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