Dupuytren's Fasciectomy
Locked fingers can be skilfully treated by Dr Oscar Brumby-Rendell.
Dupuytren’s (du-pwe-tranz) contracture is a progressive condition characterised by the thickening and tightening of the fascia beneath the skin of the palm and fingers. Dr Oscar Brumby-Rendell is and Adelaide-based orthopaedic surgeon specialising in treating upper limb and hand conditions, including Dupuytren’s contracture, and offers advanced surgical solutions to restore hand functionality.
Understanding Dupuytren’s Contracture
Dupuytren’s contracture is a condition where the fascia in the palm thickens and forms cords, leading to the fingers being pulled towards the palm. The exact cause is unknown, but genetic factors play a significant role, and it is more common in people of Northern European descent.
Symptoms of Dupuytren’s Contracture
- Small lumps/nodules on the palm
- Skin in the palm may appear thickened or dimpled
- Contractures in the palm
- Reduced finger mobility
- Permanently bent fingers
- Difficulties with daily activities
Dupuytren’s contracture can significantly impair hand function, affecting the ability to perform routine tasks and diminishing the quality of life. As the condition progresses, it can lead to permanent finger deformity if left untreated.
Receive expert diagnosis and compassionate care for Dupuytren’s contracture
Diagnosis of Dupuytren’s Contracture
Dupuytren’s is typically diagnosed very easily with a simple visual inspection of the hand! The cords and nodules are very characteristic and straight forward to diagnose for an experienced hand surgeon. A detailed medical history and discussion of symptoms are essential for managing Dupuytren’s contracture. This helps in understanding the severity and progression of the condition. Dr Oscar Brumby-Rendell will then perform a physical examination, assessing the hand for nodules and cords, and evaluating finger mobility and grip strength.
Accurate diagnosis is critical to determine the most appropriate treatment plan, whether non-surgical or surgical, to manage Dupuytren’s contracture effectively.
Non-Surgical Treatments
- Corticosteroids: Corticosteroid injections can reduce inflammation and slow the progression of contracture by decreasing the size and hardness of the nodules.
- Gamma Interferon Treatment: This therapy targets the fibrous tissue in the palm, helping to soften and reduce the nodules.
- Calcium Channel Blockers: Medications like verapamil can be used topically or injected to reduce the development of fibrous tissues.
- Percutaneous Needle Fasciectomy: A minimally invasive procedure where a needle is used to cut the contracted cords in the palm, offering symptom relief without large incisions.
- Xiaflex Collagenase Injections: Xiaflex (collagenase clostridium histolyticum) is an enzyme injection that breaks down the collagen in the Dupuytren’s cords, effectively reducing contracture. It is particularly useful for isolated, primary central cords but has limitations:
- Medicare Coverage: Xiaflex injections are not covered by Medicare, which may affect affordability.
- Complex or Multiple Cords: This treatment is not suitable for complex cases or patients with multiple affected cords.
Surgical Treatments for Dupuytren’s Contracture
When non-surgical measures are ineffective in managing Dupuytren’s contracture, surgical treatments may be necessary to restore hand function and improve quality of life.
Surgery is typically considered when:
- Non-surgical treatments fail to provide sufficient relief or slow the progression of the condition.
- The contracture significantly impairs daily activities, such as gripping objects or performing fine motor tasks.
- The range of motion in the fingers is severely limited, with fingers being drawn into the palm.
The primary goals of surgical intervention are:
- Increasing Finger Motion Range: Surgery aims to release or remove the thickened fascia causing the contracture, allowing the fingers to straighten and move more freely.
- Restoring Hand Function: By improving the range of motion, surgery helps restore the ability to perform everyday tasks, enhancing overall hand functionality and patient quality of life.
If you are experiencing significant limitations due to Dupuytren’s contracture, consult with Dr Oscar Brumby-Rendell to discuss the best surgical options tailored to your specific condition.
Types of Surgical Techniques
Fasciectomy
- Creating Small Incisions: In a fasciectomy, small incisions are made in the palm and fingers to access the thickened fascia bands causing the contracture. These incisions allow for precise removal of the affected tissue.
- Removing Thickened Fascia: The thickened fascia is carefully removed to release the contracture and restore the range of motion in the affected fingers.
- Skin Graft: In cases where significant amount of fascia and associated skin is removed, a skin graft may be used to cover the area. This helps in healing and ensures the skin remains flexible.
Finger Release Surgery (Dupuytren’s Dermatofasciectomy)
- Removing Diseased Tissue via Open Surgery: Dupuytren’s dermatofasciectomy involves open surgery to remove the diseased tissue. This procedure is typically used for severe contractures where a more extensive removal is necessary.
- Minimally Invasive Techniques: Whenever possible, minimally invasive techniques are employed to minimise trauma to the hand. These techniques help reduce recovery time, decrease the risk of complications, and optimise overall recovery.
Both surgical techniques aim to improve hand function and quality of life by addressing the underlying cause of Dupuytren’s contracture. Dr Oscar Brumby-Rendell will recommend the most appropriate surgical approach based on the severity and specifics of your condition.
Procedure Details
- Small Incisions or Open Surgery: Depending on the severity and extend of the contracture, the surgery may involve creating small incisions in the palm and fingers or using an open surgery approach for more extensive cases. Small incisions are used to access and release the affected fascia with minimal tissue disruption.
- Removing Thickened or Diseased Fascia: The surgeon carefully removes the thickened or diseased fascia responsible for the contracture. This step is crucial in freeing the fingers from their bent position and restoring their range of motion.
Dr Oscar Brumby-Rendell develops personalised treatment plans for each patient to ensure optimal surgical outcomes and minimise disruption to everyday life.
Schedule an appointment for a personalised treatment plan
Post-Surgical Care and Recovery
Immediate Post-Operative Care
After the surgery, patients will be monitored in the recovery area until they are fully awake and stable. Immediate post-operative care may include medications to manage pain and discomfort, instructions on keeping the surgical site clean and dry, and a splint to keep the fingers in an extended position to support healing.
Typical Recovery Timeline
- First Few Days: Patients may experience swelling and discomfort, which can be managed with pain medication and keeping the hand elevated. A resting splint if often recommended to help keep the fingers straight.
- First Two Weeks: Sutures are usually removed and patients can start gentle finger movements. The wounds can be slower to heal after rotational skin plasties to cover the diseased tissue that was excised.
- Four to Six Weeks: Significant improvement in hand function is typically observed, with most patients returning to light activities.
Physical Therapy and Exercises
Physical therapy may include specific exercises to improve range of motion and prevent stiffness, gradual introduction of strengthening exercises to enhance hand function, and regular sessions with a physical therapist to ensure proper technique and progress.
Returning to Normal Activities
Within a few weeks, patients can usually start light activities like writing and using utensils. More demanding tasks can be reintroduced as strength and flexibility improve, usually around six weeks post-surgery. Most patients can return to full activities, including sports and heavy lifting, within three months.
Frequently Asked Questions
Surgery is typically considered when non-surgical treatments fail to provide relief and the contracture significantly impacts daily activities, limiting hand function.
Dupuytren’s fasciectomy is highly effective in releasing contractures and restoring hand function. However, there is a possibility of recurrence, and ongoing monitoring may be necessary.
Recovery varies, but most patients see significant improvement within a few weeks. Full recovery, including returning to normal activities, may take several months. Physical therapy is crucial for optimal recovery.
As with any surgical procedure, there are risks, including infection, nerve damage, and recurrence of the contracture. Dr Brumby-Rendell takes every precaution to minimise these risks and ensure a successful outcome.
Why Choose Dr Oscar Brumby-Rendell?
- Qualifications and Experience: Dr Oscar Brumby-Rendell is an Adelaide orthopaedic surgeon with extensive training and experience in treating upper limb conditions.
- Patient-Centred Approach: Dr Brumby-Rendell prioritises your needs with a compassionate, patient-centred approach, providing clear explanations and personalised treatment plans.
- Values: Driven by commitment, passion, and integrity, Dr Brumby-Rendell is dedicated to achieving the best outcomes and maintaining the highest standards of care.
Scheduling a Consultation
To schedule a consultation with Dr oscar Brumby-Rendell for treatment for Dupuytren’s contracture, call (08) 7077 0101 or book online
Once you have a referral…
Book your consultation here.