Dupuytren’s is a condition thought to originate from Viking ancestors whereby a type of scar tissue forms in the palm and in the fingers causing the fingers to contract and curl round into the palm.
This operation is regarded as the standard procedure for Dupuytrens contracture when the condition is sufficiently advanced to interfere with function. The operation is designed to remove as much of the abnormal dupuytrens tissue as possible and to correct the contracture of the fingers. Following the operation patients require quite a lot of hand therapy and it can take some weeks or even months to get the full benefit of surgery. The recurrence risk is probably less after a fasciectomy than the minimally invasive techniques of needle fasciotomy or xiapex (collagenase) injection.
Pictures re dupuytrens-tissue (4)
Surgery is indicated when the fingers are interfering with function or the disease is progressing quite rapidly. Different techniques are available to treat the condition. Surgery is aimed at correcting the deformity of the hand and removing the Dupuytren’s tissue. It is not always successful at straightening the fingers completely. Xiapex is a new drug treatment for Dupuytrens and is used in selected cases.
This technique is used as a minimally invasive procedure for Dupuytren’s contracture of the hand. It is done under a local anaesthetic and involves breaking up the Dupuytren’s tissue with a hypodermic needle and a manipulation to try and correct the deformity. There are usually no stitches but the wounds are just covered with a plaster and patients are usually free to mobilise the hand straight away.
This technique breaks up the Dupuytren’s tissue but does not remove the Dupuytren’s tissue itself. Therefore, there is a risk of recurrence of a contracture. However, the recovery following this procedure is a lot quicker than having a fasciectomy which involves a much bigger scar and wound.
pictures dupuytrens needle fasciotomy 1 to 7 (7)
Collagenase (XIAPEX) injection is a recently licensed drug treatment for use in the UK by trained Hand Surgeons.
If it is a suitable treatment for you then the following information will be helpful.
The drug has to be prescribed and issued by a pharmacist. It comes in a state that has to be carefully mixed to an accurate solution depending on which finger or band of dupuytren’s tissue is being injected. The injection takes place in the outpatient department.
As with any drug there are potential complications. These are usually mild but can be serious so patients are advised to wait 30 minutes following the injection just in case any allergic type reaction occurs.
The hand has a dressing and bandage following the injection. It can be painful and the hand can swell. Patients should not use the hand following the injection but keep the hand elevated to keep the swelling down.
Within the next 24-48 hours you will come back to the outpatient department for another appointment. At this stage you will have another injection of local anaesthetic to make the finger numb for the “extension procedure” where the finger is manipulated to correct the deformity. Following the injection it is important to wait whilst the hand goes numb which can take 20 minutes or so. Following the extension procedure arrangements will be made to see the hand therapist for a splint to be fitted.
Occasionally the skin can tear during the extension procedure, which may require a dressing. This is particularly likely if the skin is heavily involved with Dupuytrens tissue.
You will be followed up in the outpatient department to check on your progress.
Is the treatment effective?
There is good evidence that the drug treatment works but it is not suitable for all types of Dupuytrens. The nature of the condition is that there is always a risk of recurrence whatever treatment is used. This will be discussed with you during your consultation.
When we use any new treatment for any medical condition it is important that we can follow-up patients to see how effective the treatment has been. This may involve having some measurements of the hand and questionnaires to be filled out. Sometimes clinical photographs or videos will be taken for education or training purposes. I hope that you will be happy to take part in these studies.
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Recurrence of the dupuytren’s contracture can occur after any treatment for dupuytrens.