The Upper Limb Clinic

Dupuytren's Disease

Description

Dupuytren's disease is a thickening of the layer of tissue which lies just underneath the skin of the palm and extends into the fingers. When this tissue thickens it tends to shorten as well and can form nodules and cords in the hand. Most people who have Dupuytren's disease have inherited it from their parents. The disease is particularly common in Northern Europe and has therefore been linked to Viking ancestry.

The condition is completely benign but does progress slowly and the only treatment is surgical. If left untreated the fingers will gradually contract down into the palm.

Procedure

Surgery for this condition involves removing the layer of tissue from just underneath the skin. The tendons that move the fingers are not involved in the disease process and therefore finger function is not normally compromised. A zig-zag incision is performed on the palm and up into the finger to allow removal of the thickened tissue. This is usually closed immediately afterwards but sometimes a segment of the wound is left to heal by itself if the skin has been very tight. The palm is very good at growing new skin and this takes place over a three week period after surgery.

Sometimes the skin is so heavily involved in the process that the skin needs to be removed. Should this be the case a piece of skin can be taken from the upper arm and grafted onto the finger. This is more commonly performed for recurrent disease or in patients who are very young and have severe contractures.

Recovery

It is very important to realise that Dupuytren's disease can recur in the finger that has been operated on or any other digit. Sometimes the nerves running up the fingers are so closely involved with the abnormal tissue that they can be divided during surgery. Usually the nerve can be repaired immediately and there can be a slight loss of sensation in the area supplied by that nerve.