Dupuytren’s disease is a progressive condition that causes a thickening and contracting of fibrous tissue in the hand. The fibrous tissue forms a support network in the deeper layers of the skin that provides stability for the skin.
In Dupuytren’s disease, this fibrous tissue becomes thickened. It normally starts with the development of small nodules. Eventually these nodules extend to form cords of tissue running along the line of the fingers.
The little and ring fingers are most commonly affected although the condition can occur in any part of the hand. As these cords mature, they contract, and this can cause tethering of the joints. As the condition progresses, the fingers may become more and more contracted into the palm.
Treatment options depend on the severity of the condition. Once patients are unable to fully straighten the fingers, they may wish to consider some form of intervention to try and get the hand into a more functional state.
Simple options, such as dividing the tight cord may provide some relief for patients who are not fit for a more significant operation. In an otherwise well patient, a longer incision can be made over the full length of the disease, and the fibrous tissue can be removed.
The diseased tissue often entwines around the digital nerves running to the fingers. A large portion of the operation is spent dissecting out the nerves to protect them before the diseased tissue can be removed.
In cases where the fingers have been contracted into the hands for an extended time, the skin is often tight and skin flaps may need to be created to allow closure of the skin in the new position with the fingers extended. On occasion skin grafts may be necessary.
An alternative to surgery has become available in recent years. Collagenase can be injected into the tissue affected by Dupuytren’s disease. This is an enzyme which dissolves the collagen fibres. The enzyme takes a day or two to soften the Dupuytren’s cord. The finger can then be stretched out and the cord snaps. This is a less invasive procedure but is not suitable in every case.
Dupuytren’s disease has a genetic predisposition, and patients will often have a family history of the condition. It is more common in patients with Northern European ancestry.
The extent to which the genetic basis is expressed is variable and may be influenced by many other environmental factors and constitutional issues.
There is always a risk of recurrence following surgery for Dupuytren’s disease. This is more likely in patients who have a strong family history or when the condition occurs at a young age.