Dupuytren's disease

Dr. Guillaume Dupuytren was a French surgeon living around 1800 and left his name to this disease that affects the fascia of the hands.
The opening of the fingers in extension is thus limited while the closing remains normal because the tendons are healthy.
In advanced forms, the fingers remain enclosed in the palm of the hand.
The 4th and 5th fingers are the most frequently affected, but the disease can affect all fingers and also occur as nodules on the dorsal surface of the middle joints.
Sensitivity disorders and pain may occur if the thickening of the fascia compresses the digital nerves.
A genetic factor is certainly at the origin of the disease, which explains why other family members can be affected with variable forms.
The average age is 50. The disease is more common in men than in women. The earlier the disease appears, the more aggressive it is and progresses rapidly.
This thickening of the fascia can also be expressed on the soles of the feet (Ledderhose disease) and in men on the penis (Lapeyronia disease).
No causal link between manual labour and Dupuytren's disease has been found.
However, trauma can promote its onset and aggravation.
For the moment, we do not know any treatment for this disease except the surgical procedure which consists in removing the thickening of the fascia on the palm of the hand and the retracted fingers.

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A regular preoperative check-up is carried out in accordance with the prescriptions.
The anaesthetist will be seen in consultation at the latest 48 hours before the operation.
No medication containing aspirin should be taken within 10 days of the procedure.
You should respect the fast recommended by the anaesthetist, i.e. 6 hours for solids and 2 hours for liquids before the operation.
The operation is performed under local-regional anesthesia of the arm, most often with the help of ultrasound and without hospitalization unless specifically required.

Rarely, retractable rope sections can be performed with a needle under local anesthesia.
More often, surgical intervention with skin opening is necessary and various techniques are proposed, each surgeon having his or her preferences.
One of the techniques called "open palm" consists in not closing certain surgical wounds.
This should not worry you, it is not an oversight by the surgeon or an early disappearance of the threads.
In certain exceptional situations, skin grafts or flaps may be required to close the large losses of skin substance caused by multiple resections (adjacent fingers operated on).
Again, your surgeon will tell you about this before the procedure.

Spontaneous healing is achieved in two to three weeks by renewing the bandages that will be recommended by the surgeon.
The average recovery time after this type of intervention is one month.
After the operation, when the retractions are old or severe, it is sometimes suggested to wear an nocturnal orthosis, i.e. a custom-made device that allows the operated fingers to be kept extended. Your surgeon will prescribe it to an orthotist with whom he/she usually works.
Recovery of mobility is not systematic because joints that have been ankylosed for a long time by retraction may present a stiffness that cannot be recovered after surgery.
As after any hand operation, a regional complex pain syndrome may appear, manifested by painful swelling, stiffness of the fingers requiring rapid consultation with your surgeon for management by physiotherapy and appropriate medical treatment.

About Dupuytren's disease

The usual complications of surgery are haematomas, infection, skin necrosis which can prolong the duration of healing.
A rarer complication is the section of a digital nerve during the procedure that leaves an insensitive area on a part of the finger that often decreases over time but can also leave a painful after-effect.
Your surgeon will advise you if necessary.
Recurrences and extensions of the disease are not uncommon and some patients are operated several times in both hands.
Finally, on multi-operated fingers after many recurrences, the option of amputation is sometimes considered. A joint lock may also be useful on the middle joint of the finger.
Feel free to ask any questions you may have to your surgeon who is in the best position to answer them.
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