Dupuytren Disease

Dupuytren Disease is a condition that occurs in the hands and fingers and consists of the retraction of the palmar aponeurosis (palmar fascia) with the appearance of fibrous strings that cause tension that will pull fix the fingers to the palm. It occurs more frequently in men than in women and usually affects both hands.

The first signs of the disease are the appearance of nodules in the palm, which evolve to the formation of retractile cable ties. The hand and finger joints (metacarpophalangeal and interphalangeal) will block at various degrees of flexion. The most commonly affected fingers are IV and V (ring and ear). Hand movements are hampered, especially in terms of grip and supporting items on your hands.

Factors favoring the occurrence and recurrence of the disease are:

  1. alcohol
  2. smoking
  3. diabetes
  4. drug treatment for epilepsy
  5. belonging to the northern European populations

The stages of the disease are caused by the appearance of following formations:

  • A node may be visible or can be felt, at the base of the fingers or hands. Sometimes, it may be sensitive to touch and gradually thins and starts to pull one or more fingers toward the palm.
  • A hollow depression occurs on the palm, when the affected fascia (the tissue between the skin and tendons) starts pulling the skin.
  • As the disease progresses, one or more fibrous cords develop in the fascia that will retract the fingers toward the palm, forming what is called Dupuytren's contracture.

TREATMENT

Dupuytren Disease is a chronic progressive disorder, with frequent recurrences. In the early stages of the diseas, physiotherapy is important so the patient can maintain functionality of the hand for a longer period of time. Injections of cortisone products may relieve the symptoms but do not treat the disease, nor slows its progress. If you experience pain local anesthetics like lidocaine, Marcain etc can be administered.

The classical method of treatment is the surgery of the contractile clips. A series of long palmar incision are imagined and drawn along the volar side of the affected finger which are designed to relax the contracture and also create enough skin reserves to cover the palm defects. If the skin reserves are not enough the graft method can be used (skin harvested and transplanted on the palms or fingers).

After the surgery, exercise must be practiced in order to restore hand function.

The disease recurs after surgery in variable proportions, so it often requires a new surgery for maintaining hand function. When a new intervention is done skin reserves may be shorter. The new surgery requires other incisions and other flaps to vover the defects resulting from a new intervention.

There are alternative treatments such as strength exercises which can be associated with the surgical treatment.

The AN (aponeurotomy needle) treatment or needle aponeurosis sectioning technique consists, as its name says, the use of a needle with which the affected palmar fascia in incided. The technique is done with local anesthesia and lasts for about 20-30 minutes. The procedure can be done in the consulting room, this method being minimally invasive. After applying the surgical treatment on the fibrous cords, the stress is relieved immediately, without the need for incisions or palmar skin grafts. Mobility labor can be resumed immediately without the need for immobilization splints or suture materials. The technique can be applied an indefinite number of times, the local skin resources remaining intact after each intervention. The tendency to relapse is somewhat higher than in the case of surgery.

The sooner on the disease's progression scale the intervention is applied, the better the results.

Although often not needed, it is usually better that after the needle aponeurotomy the patient undergoes 2 weeks of physiokinetotherapy in order to fully recover hand functionality.

The major advantages of this technique are:

  • can be repeated whenever needed, no matter how fast the disease recurs
  • can be applied even in the same segment that has been previously treated
  • does not require incisions, skin grafts or sutures and does not leave scars
  • it is not an open method, so the risk of infection is minimal
  • it can be successfully applied to diabetic patients
  • it does not require restraining the hand on a cast splint for 2 weeks in order to heal
  • does not cause mutilations, denervation, amputations of fingers etc., no matter how advanced the aponeurotic contracture is
  • it does not require an operator block
  • it is applicable at any age, regardless of superimposed flaws.

Results depend largely on the type of injury, its severity and the time passed since its appearance.

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