Release of Dupuytren's contracture

Dupuytren’s contracture is a connective tissue disease in which scarring occurs within the palmar aponeuroses. The palmar aponeuroses is a fibrous structure that extends from the base of the hand in the extension of the palmaris longus muscle towards the fingers. It is located under the skin and subcutaneous tissue. It protects the delicate neurovascular bundles and muscles from compression. The cause of Dupuytren’s contracture has not been clearly established. Genetic factors and the patient’s lifestyle play a major role.

• over 45 years of age
• gender (8 out of 10 patients are male),
• origin in the northern part of Europe,
• diabetes,
• smoking,
• alcohol abuse

This ailment mainly affects men over 45 years of age, and in its advanced stage, the disease severely limits functioning in everyday life. The essence of the disease is the progressive fibrosis of the palmaris aponeuroses, which causes flexion contracture of fingers – most often the ring finger and the little finger, as well as blood circulation disorders within the hand.

These changes are caused by an excessive production of collagen(a building protein in our body found, among other things, in connective tissue), of which the palmar and sole tendons (on the sole of the foot) are composed.

Various surgical techniques are used in Dupuytren’s disease. Surgical treatment is the so-called gold standard, i.e. the most popular and effectiveway of managing this condition.

• Open aponeurotomy– involves making several small incisions from which scar tissue is removed. The procedure can only be effective in contractures of a lesser degree.
• Fasciotomy – a more advanced method, during this operation the surgeon makes an incision in the hand and diseased fingers and then removes the thickened connective tissue under the skin.

Already after the operation the night pain in the hand should disappear. The next day after the surgery or on the day of the surgery the patient can get out of bed freely, move around independently and can be discharged home. The stitches are removed 10-14 days after the surgery. Until that time, care should be taken to keep the hand in place day and night.

As part of your rehabilitation, you should start moving your fingers from the second day after the operation, as much as the dressing allows. This is very important to prevent stiffness in the fingers and to prevent swelling in the hand. Also remember to exercise your elbow and shoulder.