Dupuytren's Disease

Dupuytren's is an unusual condition. The disease comes from Scandinavia, brought here by the Vikings. It's mainly of genetic origin and therefore often runs in families. The condition caused the growth of new tissue in the hands and fingers. Since these tissues have a habit of contracting, the condition often results in flexion deformities of the fingers. The process is typically painless, but sometimes prominent nodules can be painful when gripping (imagine having a pebble in your hand while gripping something hard-you get the idea). There is nothing cancerous or malignant about this. The condition is named after the French surgeon Baron Guillaume Dupuytren who also treated Napolen. Although a famous surgeon at the time, he was most unpopular with those around him and labelled as "first amongst surgeons, last amongst men".

Treament Options:

There is a lot of information on Google and Youtube and most patients know someone who knows something and clearly there are many strong opinions out there. Don't just simply take everything for granted that you read/hear/see. I'll summarise my personal opinion here regarding the various options:

Needle Fasciotomy/Needle Aponeurotomy:

This is a simple, minimally invasive way of correcting contractures, but it's not suitable for everyone. Under local anaesthetic (patient awake), a simple needle used for taking blood samples is used to cut through the diseased tissue, a bit like cutting through a taught rope. The procedure takes a few minutes. A gentle push of the finger will usually result in a good correction of the deformity. This works best for deformities of the MCP-joints (the first of the 3 finger joints).

Advantages: minimally invasive, quick, minimal rehab implications, very quick return to work/normal life.

Disadvantages: higher recurrence rate than open surgery.

My take: I think it's a great procedure for suitable patients and often my preferred first choice of treatment. Careful patient selection is the key to success.

Segmental Fasciectomy:

This is an alternative for patients where a needle fasciotomy is not possible, but where open surgery may not be required. Under local anaesthetic one or 2 small incisions are made to remove some (but not all) of the diseased tissue. Works well in some patients.

My take: slightly more invasive than a needle fasciotomy but achieves similar outcomes with minimal rehab implications and a low risk of complications.

Open Fasciectomy:

This is the traditional way of treating deformities. Typically carried out under general anaesthetic (patient asleep), but sometimes local anaesthetic can be used. A zig-zagging incision is made form the palm to the finger tip and the diseased tissue is removed. This is for those patients where the presentation is more advanced and less invasive methods are no longer suitable.

Advantages: Deals even with the worst deformities, lower recurrence rates than minimally invasive options.

Disadvantages: More invasive, longer rehab, higher risk of complications.

My take: When minimally invasive options are not suitable, this will still work. Rehab takes a bit longer, but functional outcomes are still good. In very bad deformities, even open surgery may not result in a perfectly straight finger.

Xiapex/Collagenase:

This is a minimally invasive injection treatment. A special fluid is injected into the diseased tissue. The fluid digests the collagen fibres in Dupuytren's tissue. One or two days later a gentle manipulation under local anaesthetic is carried out to straighten the finger. This treatment is relatively new and works well, but careful patient selection is all important. This is not suitable for everyone.

Advantages: Minimally invasive, quick rehab, quick return to work and normal activities of daily life.

Disadvantages: Higher recurrence rate than open surgery, expensive.

My experience with Xiapex has been very good, but clearly this is not suitable for every patient and success is not always guaranteed (but the treatment can then be repeated). Minor side effects/complications are frequent: bruising, swelling and sometimes skin tears (although they tend to heal quickly).

Xiapex Injection for Dupuytren's Contracture

Unfortunatley Xiapex is currently not available in the whole of Europe. However, for carefully selected patients a treatment called Needle Fasciotomy can be equally effective and minimally invasive as treatment with Xiapex.

Skin Grafts:

Sometimes needed in particularly bad cases and revision surgery when there may not be enough skin to close the wound at the end of an operation. The graft is typically harvested from the forearm. I only use grafts if there is no other option.

Radiotherapy:

I've got no personal experience with this. The scientific literature suggests that it works in some patients, but the method is not in widespread use in the UK.

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