Dupuytren’s disease is related to a thickening of a fibrous structure located under the skin of the palm of the hand and fingers. This thickening is accompanied by a retraction which limits the extension of the fingers and can infiltrate the skin. The retraction of the fingers is not accompanied by pain. Dupuytren’s disease is more frequent in northern Europe and more often affects man than woman. Often, another member of the family also presented the disease (hereditary disease). Some medications or alcohol may promote this disease.
WHEN IS THE SURGERY INDICATED?
The intervention can be considered from the moment when the patient can no longer lay his hand flat on the table. The treatments differ ccording to the nature and the importance of the lesions (deficiency of extension, condition of the skin).
– Regional Fasciectomy: This is the most used treatment. Zigzag incisions are made in the palm and along the fingers.This allow the removal of abnormal tissue responsible for the flexion of the fingers. The incisions take between two and three weeks to heal and will be thick for several months. Reeducation and wearing a splint to extend the fingers are very often necessary. Occasionally, skin grafts may be needed to replace damaged skin. This makes this operation tricky and the proximity between abnormal tissues and vessels and nerves. Dissection and ablation of abnormal tissues in contact with vessels and nerves is difficult and should always be done with microsurgical glasses.
– Injection of Clostridium Histolytcum Collagenase: A product is injected which will dissolve the pathological tissues within a few days. This new method can be carried out in the same cases as an aponeurotomy, but more often in easy cases or patients with lot of morbidity.
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