Dupuytren’s Disease
Dupuytren's disease causes abnormal thickening of the connective tissue in the palm, forming cords that progressively pull one or more fingers into a bent position toward the palm — most commonly the ring and little fingers. The condition tends to progress slowly over years and is more common in men, people of Northern European descent, and those over fifty. While surgery does not cure the underlying disease, it can significantly improve finger extension and hand function.
Treatment Options for Dupuytren's Disease
Treatment is guided by severity and patient factors. A positive tabletop test — inability to place the hand flat with fingers extended — is a common indication for intervention.
Needle aponeurotomy: A minimally invasive office procedure in which a needle is used to divide the cords through small skin punctures under local anaesthetic. Quick recovery, but higher recurrence rate (thirty to fifty per cent within five years). Best for MCP joint contractures and older or frailer patients.
Collagenase injection: An enzyme is injected into the cord to weaken it, followed by manipulation to rupture and straighten the finger twenty-four to forty-eight hours later. Office-based with moderate recurrence rates.
Limited fasciectomy: The most common surgical approach. The diseased cords and nodules are excised through carefully planned incisions under regional block or general anaesthetic. Suitable for most cases, with recurrence rates of twenty to thirty per cent over five to ten years.
Dermofasciectomy: Diseased fascia and overlying skin are excised together and the defect covered with a skin graft. Reserved for severe or recurrent disease. Lower recurrence rates.
Your Recovery
After limited fasciectomy, hand therapy begins within one week and is critical for success. Therapy includes oedema management, exercises, splinting (often a night extension splint for three to six months), and scar management. Most patients return to desk work at two to three weeks and to heavy manual work at eight to twelve weeks.
Risks and Complications
Nerve or arterial injury (nerves run very close to diseased cords)
Wound healing problems or wound separation
Joint stiffness — PIP joints may not fully straighten
Haematoma or seroma
Complex regional pain syndrome (rare but serious)
Recurrence of contracture
Need for skin grafting if wound cannot be closed
Frequently Asked Questions
Will the disease come back after surgery?
Recurrence is possible because surgery treats the contracture, not the underlying disease. Recurrence rates vary by technique and disease severity, and younger patients with aggressive disease have higher risk. Despite this, surgery provides years of improved function.
Should I wait until it gets worse?
Moderate contracture — thirty to sixty degrees — is generally the optimal time for surgery, before joints become stiff and skin compromised.
Will I fully straighten my finger?
MCP joint contractures usually straighten well. PIP joint contractures, particularly longstanding ones, may not fully correct.
THE SPECIALIST CLINIC DUBLIN
Plastic, Reconstructive & Aesthetic Surgery performed with Care & Compassion
To discuss Dupuytren's disease and your treatment options, contact us to arrange a consultation with one of our consultant plastic surgeons.