Treatment of Dupuytren's contracture

What is Dupuytren's contracture?

Dupuytren's contracture is a pathology of   the palm and fingers. In a healthy hand, there is a thin layer of connective tissue called fascia, which covers important nerves, blood vessels, muscles, and tendons, and also stabilizes the skin. In Dupuytren's contracture, the fascia undergoes pathological changes. Lumps and nodules form on the palm, gradually causing the fingers to bend. The disease is progressive, gradually accompanied by pain, loss of function, and other complications.

What causes Dupuytren's contracture? 

The exact cause of Dupuytren's contracture is unknown, but it is known to be hereditary. It is the most common hereditary connective tissue disorder. Dupuytren's contracture is more common in men over the age of 40. Risk factors for the development of the disease include smoking, alcohol consumption, diabetes, low body mass index, etc.

There is no evidence that certain types of work or hand injuries increase the risk of developing the disease.

What are the symptoms of Dupuytren's contracture?

Dupuytren's contracture can develop over months or years, so symptoms may not be apparent in the early stages. Symptoms of the disease usually develop in the following order:

• Nodules — small bumps under the skin on the palm of the hand are the first sign of Dupuytren's contracture. They usually appear at the base of the fingers, where the fingers connect to the palm. In some cases, patients never develop any symptoms other than nodules, and in some cases, the nodules disappear on their own. The nodules may cause the skin around them to tighten.
• Dense  bands — over time, the nodules can thicken and form long, rope-like tissue formations on the fascia, which cause the fingers to contract toward the palm.
• Contracture — eventually, the bands can become so dense and thickened that the affected fingers cannot be fully unbent or straightened.

Unlike other diseases, the worsening of symptoms of Dupuytren's contracture is not usually associated with any specific cause. Symptoms may worsen over time, and in some patients may remain at the initial stage.

Occasionally, symptoms such as the following may develop:

• swelling;
• itching;
• burning or pain sensation.

How is the disease diagnosed?

Dupuytren's contracture is usually diagnosed based on a physical examination and assessment of symptoms. Blood tests and X-rays may be ordered.

During diagnosis, attention is paid to the presence of nodules and bands, as well as the quality of finger compression. The doctor may ask the patient to place the  open palm on a flat surface — if the fingers do not fully touch the surface and there is space between the palm and the surface, this may indicate contracture.

How is Dupuytren's contracture treated with microsurgery?

The goal of treating Dupuytren's contracture is to improve the extension of the affected fingers and restore hand function. The treatment method depends on the stage of the disease, the severity of the symptoms, and the individual needs of the patient.

When conservative treatment methods are not enough, microsurgical surgery is prescribed. During microsurgical surgery, magnifying devices allow the surgeon to see the delicate structures of the palms and fingers in detail and precisely remove the pathologically altered fascia and tendons with minimal damage to healthy tissue.

Microsurgical procedures for treating Dupuytren's contracture:

• Fasciectomy — the most common microsurgical procedure for treating this condition, in which the damaged fascia and bands  are removed completely or partially.
• Fasciotomy — only the bands are removed, along with small areas of skin. This is a less invasive method, but the risk of recurrence is higher.
• Dermofasciectomy — in complex cases where the skin is significantly damaged, removal of the skin and fascia followed by skin grafting may be necessary.

After surgery, rehabilitation is prescribed to  fully restore hand function, reduce pain, and consolidate the results of the operation.

What complications can arise during microsurgical treatment of Dupuytren's contracture?

Microsurgical operations performed to treat Dupuytren's contracture, like any other surgical intervention, may be accompanied by the risk of certain complications. These complications can be mild and temporary or more serious and long-lasting. Postoperative complications may include:

• Bleeding;
• Infection;
• Recurrence of the disease;
• Complex regional pain syndrome.