Dupuytren`s contracture

Dupuytren’s contracture, or palmar fibromatosis, also called Viking disease, is a progressive connective tissue disease. In the process, knots and reinforcements are formed inside the wrist. Over time, the bars tighten, bending their fingers and making them unbending.

Dupuytren’s contracture is a slowly progressive formation of connective tissue adhesions that cannot resolve on its own.

When a finger contracture or contracture is detected, it is necessary to perform an operation to cut out these bars and nodes, recovering the finger movement. Unfortunately, fibromatosis occurs in all connective tissues of the wrist, so it is not always possible to prevent the recurrence of contracture. In most cases, one operation is sufficient, but in the case of an aggressive Dupuytren’s disease, several surgeries may be needed during the patient’s lifetime.

Surgery is needed when you can no longer place your palms and fingers straightened on the table. The best results of the operation are expected while the total finger contracture doesn’t yet exceed 90 degrees. In such cases, full recovery of finger movement is rare, i.e. the contracture may persist. In case of severely tightened fingers, a longer operation and recovery time are required, as well as more frequent visits to an occupational therapist during the recovery period.

The operation is usually performed under local anesthesia – the doctor injects medicine into your arm, making it numb. In milder cases, the operation lasts about an hour, in complex cases, its length can reach several hours. During the operation, cuts are made over the bars and knots, sometimes prolonging from the wrist base to the fingertips.

A skin defect often develops after fingers are straightened. It can be eliminated by forming extension cuts or z-plastic. In more severe cases, it is necessary to transplant the skin or move the skin levers from the adjacent fingers. Sometimes the wound is left to expel excess fluid and blood, or rubber strips – drains – are placed in the wound. At the end of the operation, a bandage is applied, sometimes also a plaster.

Keep your hand at heart level for at least 4-5 days after the surgery. This will help to reduce swelling and allow your fingers to recover more quickly. You can hold your hand yourself or use a tie, handkerchief, or a special shoulder bag. However, remember that you need to move your shoulder and elbow joints every day, as well as any bandage-free joints so that they don’t become stiff. At night, place your palm on a pillow at chest level for at least a week to reduce swelling.

The wound may hurt for the first 2-3 days. Usually, the pain after the operation is not severe and simple painkillers recommended by your doctor are effective against it. The most commonly recommended dose is Ibuprofen 400mg, 1 tablet 3 times daily for 5 days, or Solpadeine 2 tablets 4x daily for 3 days. You can also take any other painkiller that you have at home and that provides relief. Talk to your surgeon or family doctor about choosing a particular painkiller. Be sure not to take more than one medicine at a time and do not exceed the recommended dose! In case of doubt, always consult a doctor.

Usually, after Dupuytren’s contracture surgery, a bandage change is required the next day or the day after, especially if the drainage is left in the wound. The days of bandage change will be determined by your doctor at the time of discharge. The bandage is painless, but keep in mind that the bandage will be exacerbated. The drains are removed in the first bandage. Subsequent dressings will be once every 2-3 days if the wounds heal well.

Sutures are usually removed on the 12-14th day. Depending on the wound healing progress, sutures can be removed in parts or at once. Be aware that after removing the sutures, the wounds may open in areas where blood has accumulated or has the greatest stretch. Then you will need to wear a bandage longer. However, it is important to remember that finger exercises should be started regardless of the presence of small wounds because sooner or later all wrist wounds will heal. But untrained fingers often remain stiff.

After uncomplicated Dupuytren’s contracture surgery, you will not be able to work physically for 4 weeks. In case of complicated contractures and surgeries, the incapacity for work can last for 2-3 months, because it is necessary to perform occupational therapy and physiological procedures for maximum recovery of movement.

The final result is usually reached within 3-6 months when the scars are fully healed and the fingers reach the maximum possible movement.