Dupuytren’s contracture is a disorder of the interfacing of the palm deep to the skin of the hand. Thick nodules and scar like tissue forms in the area typically over the ring and little fingers. This can result in deformity, pain and functional inability to straighten the involved fingers. When the condition worsens to the point of restricting movement in the hand, surgical release is necessary.
Surgery is the only treatment for Dupuytren’s contracture when it becomes advanced. The surgery involves cutting the bands of thickened tissue, freeing the tendons and allowing better finger movement. The operation must be done precisely, since the nerves that supply the hand and fingers are often bound up in the abnormal tissue. In some cases, skin grafts are needed to replace the tightened and puckered skin, though skin expansion with zig-zag closure is often sufficient.
The results of the surgery will depend on the severity of the condition. You can usually expect full return of function, particularly after physiotherapy and splint wear. Scar management is carried out during the healing phase with silicone gel and massage. Risks include skin wound separation, bleeding and infection, rarely. Reasonable rates of recurrence are 40 % at 20 years.
Following Your Treatment
Since the hand is a very sensitive part, you may require pain medication post operatively. Tylenol # 3 is usually sufficient. However, there is occasionally need for stronger medication as well as long acting anaesthetic at the time of the surgery. Your hand must remain immobilized for approximately one week. After which the sutures are removed and the physiotherapy is initiated. Your therapy may involve hand exercises, heat, massage, electrical nerve stimulation, splinting, traction, and special wrappings to control swelling. Keep in mind that surgery is just the foundation for recovery. It’s crucial that that you follow the therapists instructions and complete the entire course of therapy if you want to regain the maximum use of your hand.