Therapy of Dupuytren’s disease

Synonyms

Dupuytren’s contracture; fibromatosis of the palmar fascia, Dupuytren’s ́sche Disease

General / Introduction

Depending on the stage of the disease, Dupuytren’s disease can be treated in different ways. Unfortunately, the usual conservative measures such as physiotherapy are ineffective, so that surgical therapy is often resorted to. In the following, the individual therapy options, their application, advantages, disadvantages and chances of success are described.

The stages of Dupuytren’s disease are classified according to the extension deficit. The degree of bending contracture of all joints of an affected finger is added together. This results in four different stages of Dupuytren’s disease: In order to be able to completely escape from a therapy, Dupuytren’s disease should be prevented. Knowledge of the causes is again relevant for this.

  • Stage I: 0 to 45
  • Stage II: 45 – 90°
  • Stage III: 90 – 135
  • Stage IV: > 136

Hand surgery = surgery of M. Dupuytren

Hand surgery is still the most common form of therapy for Dupuytren’s disease. It serves to restore hand function and can be used as the only therapy in all stages of the disease. However, the operation is a relatively major intervention, so this type of therapy is usually only used in cases of severe loss of function.

In order to restore functionality, an attempt is made to free the hand tendons from all connective tissue strands and knots. In a total fasciotomy, the affected tissue and the aponeurosis of the palm are removed generously. However, since this is a very large procedure with the risk of a complete loss of hand function, this technique is rarely used today to treat Dupuytren’s disease.

The most frequently used technique at present is partial fasciotomy. In this procedure, the affected tissue and possibly parts of the aponeurosis are removed. However, the functionality of the hand can be retained.

Nodal fasciotomy is the removal of the nodules and partially the cords. However, the aponeurosis remains intact. Depending on the stage of Dupuytren’s disease, the strands are not completely removed but only cut open.

Segmental aponeurectomy is a very small procedure that only removes individual segments of the strand. The aim of this procedure is to interrupt the strands and thus to remove the contracture. In some cases, the contracture can be removed forever.

In some cases, however, the strands can be re-formed. The largest intervention in Dupuytren’s disease is dermofascicectomy. Here the affected tissue and the overlying skin are generously removed, and the skin is replaced by the body’s own skin graft.

If this is completely successful, a recurrence of the disease can be prevented in most cases. However, this is an extensive procedure, which carries a high risk of infection and requires a long healing period. If the procedure is successful, the hand can usually be used again fully and the fingers can be stretched out completely.

If the fingers have already been curved for a long time, it is possible that only a partial extension can be achieved. The reason for this is the adaptation of the finger tendons to the curvature position. Nevertheless, a significantly better functionality can be achieved.

Following surgery for Dupuytren’s disease, follow-up treatment is recommended in some cases. However, the benefits of this treatment are not fully established, so there are no specific recommendations for follow-up treatment. However, it is advisable to discuss the post-operative treatment plan with the operating surgeon and to consult a physiotherapist specializing in Dupuytren’s disease for follow-up treatment.

It is also possible that Dupuytren’s disease may recur after surgery. This is related to the type of operation and the way it is performed. However, other risk factors such as localization of the contracture (thumb or little finger affected) and male gender are also associated with a higher risk of recurrence.