Dupuytren’s contracture is essentially a deformity of the hand and usually develops gradually over the years. In this condition, a tissue layer beneath the palm skin gets affected. There is a formation of tissue knots that ultimately creates a dense cord, pulling one or more than one fingers of the hand into a tilted position.
Causes and Symptoms
There isn’t much clarity as to the actual cause of Dupuytren’s contracture, but it is understood that it does not result from heavy use of the hand or injury. A couple of factors can put you at a higher risk of developing this condition. These include the following:
• Dupuytren’s contracture is a hereditary disorder and usually runs in one’s family.
• It may be related to specific medical conditions like seizures and diabetes.
• It might be more common among aging adults.
• It could be associated with alcohol consumption.
Dupuytren’s contracture primarily affects the small (pinky) finger and the ring finger of the hand. This condition usually progresses at a slow pace and may take years to fully develop. At the onset of Dupuytren’s contracture, you will experience your palm’s skin becoming thicker or denser. With gradual progression, the skin may start to appear dimpled or puckered. You may see a tough tissue lump begin to form on the palm. The lump isn’t usually painful, but you might experience a sensation upon touching it.
In the later stages, you will experience the formation of tissue cords under the palm skin, and these may extend all the way to the fingers of your hand. With the tightening of these cords, your fingers will get pulled towards the palm, often severely.
The treatment administered for Dupuytren’s contracture is usually dependent on the seriousness of your condition. When the case isn’t too severe, a minor surgical procedure called needle fasciotomy might be recommended.
Needle fasciotomy, also called percutaneous needle fasciotomy or aponeurotomy, is typically performed on an outpatient basis under local anesthesia. This helps in numbing the hand to pain without the need to put the patient under.
After the numbing is complete, the surgeon will carefully insert a very fine needle or blade into the dense and fibrous bands present in the palm or fingers of the hand. This will help in dividing the cord underneath the skin. Once the dense tissue is divided, the surgeon will be able to discharge or loosen the tightness that was gripping the hand and forcing the fingers to tilt.
An open fasciotomy may sometimes be used for treating more serious cases. This procedure involves removal of the thickened and dense connective tissue and has three variations:
• Regional fasciectomy: A large single incision is made for removing the damaged connective tissue. Regional fasciectomy is the most common type of surgical method used for treating Dupuytren’s contracture.
• Segmental fasciectomy: This method involves making one or more small incisions for removing tiny sections of the connective tissue.
• Dermofasciectomy: This option involves removal of the damaged connective tissue as well as the affected overlying skin. Skin grafts may be required in this method.
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Dr. Morwood has over 20 years’ experience as a plastic surgeon, he is certified by the American Board of Plastic Surgery, he is a member of the American Society for Aesthetic Plastic Surgery, and for years he has served as either the chief or vice chief of the Division of Plastic Surgery of Monterey.
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