Dupuytren's contracture release surgery
Release surgery is used to correct Dupuytren’s contracture, a disease that usually begins with a thickening of the skin in the palm of the hand. Eventually the disease may develop into a thick band that could make your fingers contract or pull into the palm of your hand. The exact cause of Dupuytren's contracture is unknown, though it is thought to be a hereditary disease and not related to overuse or injury of the hand.
Specific treatment for Dupuytren’s contracture is determined by the severity of the disease, your age, tolerance for medications and your medical history. Nonsurgical treatments can include:
- Needling – This procedure consists of sticking a needle through the skin and puncturing the thickened cord which is contracting the finger. The desired result is to break apart the cord and ultimately to release or relieve pressure on the affected finger. Doctors can now use ultrasound imaging to guide the needle and can repeat the procedure as necessary. There are no incisions involved in this procedure, and it can be performed on several fingers at one time. The only limitation is that needling cannot be used in some areas of the finger as it could possibly result in nerve damage.
- Enzyme injections – This procedure aims at softening and weakening the thick cord with injections of enzymes. The day after the injection, your doctor will attempt to break the cord by manipulating your fingers. This injection can sometimes be more painful than needling, can be done only on one finger at a time and requires one month between treatments.
During Dupuytren’s contracture release surgical treatment, the surgeon makes an incision in the hand and cuts the area of thickened tissue. This allows for improved movement of the tendons and increases finger mobility. It is a very precise surgery, because the nerves in the hand are often in this area of thickened tissue. Sometimes skin grafts are needed to replace the overlying skin. Skin grafts are performed by taking a piece of healthy skin from another area of the body (called the donor site) and attaching it to the needed area. After surgery, physical therapy helps increase strength and function.
While surgical treatment for Dupuytren’s contracture may increase the mobility of the finger(s), it does not help correct the underlying disease process. The results of surgery do tend to be more permanent or last longer than those of nonsurgical treatments. About 20 percent of patients have some degree of recurrence that may require further surgery.