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Dupuytren’s contracture surgery, palmar fasciectomy

What is a Dupuytren’s contracture?

Dupuytren’s contracture, also known as Viking disease or the contraction of the palmar fascia, is the disease of the layer of tissue that lies under the skin of the palm. It causes the abnormal thickening and contraction of the fibrous connective tissues of the palm, which leads to the fingers to bend and can impair finger function.

Rarely, the lesion could appear on other parts of the body as well: as lumps on the back of the finger joints (Garrod’s pads), lumps in the arch of the feet (Ledderhose disease), or under the skin of the penis.

What could cause Dupuytren’s contracture?

The exact cause of Dupuytren’s contracture is unknown, however, genetic predisposition could be inherited recessively. It means its appearance does not necessarily affect all generations. The occurrence of the disease is most common among the Northern European population, its regional spread could be connected to the Viking migration. This is why it is often called Viking disease.

Dupuytren’s contracture forms due to the benign tumor of the palmar fascia. The contracture first presents as a thickening or nodule in the palm, which is usually painless. After a while, these nodules form a cord towards the finger, which cause the contraction of the palmar fascia and later the bent of the finger. The most common finger to be affected is the ring finger, the small finger, and sometimes the middle finger. Usually, both hands are affected, but the contracture is more advanced on the dominant hand.

Dupuytren's contracture formation
Dupuytren's contracture formation

Risk factors include diabetes, smoking, epilepsy and previous hand trauma.

Mostly men are affected, between the age of 30-40.

The course of the disease is progressive, without treatment, the condition of the hand is getting worse constantly.

What are the symptoms of Dupuytren-contracture?

Dupuytren’s contracture has different symptoms at each stage. The condition usually begins as a thickening of the skin on the palm. As it progresses, the skin of the palm might appear puckered or dimpled. A firm lump of tissue forms on the palm, which might be sensitive to the touch but usually not painful.

At the next stage, cords of tissue forms under the skin on the palm which can extend up to the fingers. As these cords tighten, blocking the fine movements of the fingers. Most of the patients visit an orthopedic specialist at this stage. In the advanced stage of the disease, the fingers might be pulled toward the palm, sometimes unmovable.

Dupuytren’s contracture progresses slowly, over years, but it is difficult to predict how the disease will progress. Some people have only small lumps or cords while others will develop severely bent fingers.

How is Dupuytren’s contracture diagnosed?

Dupuytren's contracture test
Dupuytren's contracture physical examination

Dupuytren’s contracture is diagnosed by physical examination. An orthopedic specialist or a hand surgeon can set the diagnosis by touch and visual check, special examinations are not needed.

How is Dupuytren’s contracture treated?

The treatment of Dupuytren’s contracture depends on the stage of the condition. In an early stage, if the hand function is good and the lumps don’t cause pain or any inconvenience, observation is enough. Steroid injections may reduce the inflammation. If the cords are already formed, but the movement of the fingers are just minimally limited, physiotherapy could help to slow the progression of the contracture.

If the lesion blocks completely the movement of the fingers, fasciectomy is recommended.

When Dupuytren’s contracture surgery is recommended?

Dupuytren’s contracture is a progressive disease, the condition is getting worse gradually and the progress cannot be reversed. If the complaints hold the patient from his daily activity, the finger movements are limited or the contracture is in an advanced stage and the fingers are completely bent to the palm, the surgical release is recommended.

The goal of the surgery is to improve finger motion and function; however, complete correction of the fingers may not always happen. The result of the surgery depends on the stage of the disease. In an early stage, the functions of the hand can be restored completely, but if the scarring is advanced, the possibility of function loss is high.

What happens during the surgery?

Palmar fasciectomy is performed under general, regional or local anesthesia, depending on the severity of the contracture. During the intervention, the hand is in ischemia to protect the surrounding nerves and vessels.

In case of a mild lesion, the surgery is performed in local anesthesia, by releasing the contracted fibers, with a needle or via a few millimeter incision.

If the contracture is in an advanced stage, fasciectomy is performed in general anesthesia. The hand surgeon makes Z-shape incisions above the contracted cords, he incises the diseased cord and tissues, release the joint capsule and perform Z-plasty if necessary.

Dupuytren's contracture surgery - Medicover Hospital Hungary
Dupuytren's contracture surgery

What are the risks of the operation?

Like every surgical intervention, Dupuytren’s contracture surgery may have risks and complications. Very rarely the operational area may become inflamed, infected, and the adjacent anatomical structures – tendons, muscles, blood vessels, nerves, neighboring bones – may get injured. In some cases, pharmaceutical treatment may be needed, while in more severe cases the operation might have to be repeated.

After hand surgery
After hand surgery

What shall I do after the surgery?

Dupuytren’s contracture surgery is performed as a one-day surgery. After a few hours of medical monitoring, the patient can leave our hospital. However, in case of a severe contracture, where the cords were removed, 24 hours monitoring is recommended.

The day after the surgery, the bandage should be changed, and the removal of the stitches is due 10 days after the intervention. During these days, keep the wound away from water.

After cord transcision, the patient can use the operated hand the day after. In a severe case, where the cords were removed, the hand should be spared until wound healing. In both cases, 3-4 weeks after the surgery, the physical exercising of the hand and fingers are highly recommended to facilitate the recovery.

The wound may remain swollen, sensitive and painful for a few days after the surgery.

The full recovery, the regeneration of all functions of the hand, takes 3-4 weeks after a cord transcision and 8-12 weeks after a cord removal.

How much does a Dupuytren's contracture removal cost?

The price of a Dupuytren’s contracture surgery is composed of several elements. At our hospital, the listed palmar fasciectomy cost includes the surgery and the check-up one week after surgery.

We offer a separate consultation package for the first consultation, where the hand surgeon specialist decides if the surgery is recommended. The necessary pre-operative examinations can be taken at our hospital, which has an additional cost.

Our goal is to offer you the most reasonable Dupuytren’s contracture surgery price for the highest quality service and care.

Medicover Hospital Hungary
Medicover Hospital Hungary