Dupuytren's disease is a retractile fibrosis of the palmar aponeurosis of the hand (the aponeurosis is a membrane located between the flexor tendons and the palm). It progressively leads to irreducible retraction and flexion of the fingers. It manifests itself by the formation of nodules and flanges located in the palm and/or on the palmar surface of the fingers.
What causes Dupuytren's disease?
- It is essentially a hereditary disease, preferentially affecting men. The evolution is very variable: a few months or several years may be necessary to see the appearance of a progressive flexion of the fingers, due to the retractile properties of the disease. Any finger can be affected with a predominance for the ring and little fingers.
What treatments can be offered for a disease?
No medical treatment has been successful to date. Only surgical treatment can correct digital deformities.
Surgery becomes necessary when Dupuytren's disease becomes troublesome in the patient's daily activities, or even painful during strong gripping movements (pressure exerted on the fibers and nodules formed by the disease). The indication for surgery is also given when the patient cannot put his hand flat anymore because of irreducible deformations in flexion of the fingers.
Any surgical procedure can be performed using two techniques:
- needle aponeurotomy which is a simple technique, not very disabling, reserved for simple cases of Dupuytren's disease and consisting in cutting the retractile flange through the skin, with a sharp needle. This technique is attractive because it is not very aggressive but recurrences are frequent because the diseased tissue remains in place. It must therefore be performed sparingly.
- The aponeurectomy remains the reference technique because it allows a complete removal of the diseased tissues, tissues at the origin of the deformities in flexion of the fingers.
This is an outpatient procedure (the patient does not sleep in the clinic), under loco-regional anesthesia (only the arm is put to sleep). It consists of an excision of the fibers and/or nodules. The retraction of the fingers can be accompanied by a skin retraction, implying the realization of gestures compensating for this lack of skin (graft, flap).
Post-operatively, 48 hours after the operation, re-education sessions are started early in order to recover the mobility of the operated digital chains as soon as possible. The re-education sessions can be accompanied by a specific apparatus which will allow to finish the reopening of the finger, when the surgery alone did not allow it (in the severe forms of Dupuytren's disease).
What is the evolution after surgical treatment?
When the operation is performed early enough, i.e. on a moderate retraction of the fingers, it allows recovery of full extension of the operated fingers. The recovery time of the hand function for everyday use is usually three to four weeks. The time should be doubled for a heavy worker.
When Dupuytren's disease is advanced, one can be exposed to an incomplete recovery of the extension of the fingers, even by associating surgery and physiotherapy. The risk of recurrence and/or extension to other fingers exists, independently of the quality of the surgical work.
In advanced forms of the disease, dissection of anatomical structures during surgery is often difficult and the surgeon may accidentally cut the nerve of a finger. Even after microsurgical repair, sensation may never be completely normal, hence the value of early intervention in Dupuytren's disease.
Finally, Dupuytren's disease can be associated with other identical pathologies affecting other segments of the body: Ledderhose's disease affecting the soles of the feet and Lapeyronie's disease affecting the corpora cavernosa and causing a deformation of the penis.