Dupuytren's disease - minimally invasive surgery is the answer
Dupuytren's disease - minimally invasive surgery is the answer

Dupuytren’s disease – minimally invasive surgery is the answer

Dupuytren’s is a genetic disease with no known cure. It produces a thick layer (fibromatosis) underneath the skin which proliferates towards the fingers, forming a fibrous cord, which gains contractile properties.

This cord, when contracting, causes the fingers to lose mobility, particularly the ability to extend. Despite not having a cure, Dupuytren’s disease can be treated, which includes excision or fractioning of the fibrous cord to permit the extension of the fingers.

The disease can flare up in stages, with more and less active phases.

It can remain unalterable, as is the case with, for example, a small palmar nodule, without any evolution for years, and in an active phase of the disease, a finger can retract, preventing its extension.

As there is no cure for this disease, the only solution is surgery. There are two options: classic surgery and percutaneous surgery. In classic surgery, the skin is opened up and the fibrotic cord is removed. In percutaneous surgery, the cord is weakened at multiple points using a needle, preserving the skin.

With the classic method the postoperative period is longer and has a higher rate of complications. With the percutaneous method, there are fewer complications, and it permits immediate use of the hand. However, it has a higher recurrence rate.

The relapse rate depends, for both techniques, on the outbreaks of the disease, which are unpredictable. When surgery takes place before a period of calm, when the disease is inactive, good results are obtained. When the surgery is performed before an outbreak, we have a bad result, with an early relapse.

This percutaneous technique was first introduced in Portugal by the HPA Gambelas hospital in 2003, as a result of our contact with colleagues from the Centre de la Main de Toulon. More than 90% of our patients are treated using the percutaneous technique.

We consider it ideal for patients who have a higher recurrence rate and who, on average, need to repeat the procedure every four years.

Depending on the severity of the disease, there is usually a need for rehabilitation with specific hand therapy techniques and sometimes the use of splints.

Possible complications, which are more frequent in open (classic) surgery, include delays in skin healing, digital sensory lesions, resulting in an altered sensitivity in part of the finger, infection, among others. The frequency of these complications increases when classic surgical reinterventions are necessary.

Despite some discomfort, percutaneous surgery permits the use of the hand the day after the intervention, but it may justify a week off work for the heavy manual worker. Classic surgery requires a three- to six-week break.

Rehabilitation and the use of a night splint after surgery are an important factor for a good recovery, regardless of the surgical technique to which the patient was subjected.

From the first day after surgery, the patient will have to perform a set of exercises, that is, a self-re-education programme to be carried out at home. These exercises are essential to combat oedema, pain, stiffness and tissue retraction.

Article submitted by the HPA Group