Dupuytren's contracture is a thickening and shortening of the layer of tissue just under the skin but above the tendons. It can cause lumps or dimples in the skin of the palm, and can slowly draw the fingers down into the palm by forming shortened cords across the finger joints. Doctor G. Dupuytren was a French surgeon who wrote about the condition in the 1700’s.
A layer of tissue under the skin called fascia binds the skin to the skeleton. It is this tissue that is affected by Dupuytrens contracture.
The ring and little fingers are most commonly involved, but any part of the hand may be affected, as well as the sole of the foot.
The condition is inherited. It is harmless other than the gradual loss of function of the hand from the bent fingers.
Surgery or Collagenase injections are the main treatments that can get the fingers out straighter.
The tight cords of tissue holding the fingers bent can be cut out. A simple test of when an operation might be considered is when your hand can’t be flattened on a table.
The operation is done through combinations of zigzag and straight cuts in the palm and fingers. There often is a shortage of skin along the length of the palm or finger. This can be helped with skin grafts or moving skin flaps around with a Z plasty.
After surgery, many weeks of hand physio and splinting is needed.
Surgery is not a cure, and new Dupuytrens tissue may form in other parts of the hand or in the surgical scar.
This is an enzyme that dissolves collagen, the gristle in the cords. It is given by direct injection, followed a few days later by a manipulation to break the dissolving cords. A splint and hand physio is still needed afterwards, but the recovery time is shorter than surgery. The correction or improvement is at times less than surgery, and not every Dupuytrens is suitable for injection. Collagenase is not a cure, and new or recurrent Dupuytrens cords may form in the future.
Collagenase/ xiaflex patient brochure
Which one for me and When?
The best treatment depends on your hand and a few other factors. It is best decided after discussion with Dr Hile.