Dupuytren's contracture
Due to shrinking and swelling of the dense fibers under the palm skin, usually the little finger begins to bend and later also the ring finger. Other fingers can also be affected but much less frequently. These fingers can then not be stretched. This disease causes no pain and therefore they are long ignored by the patients (mostly men). This deformity interferes during handshakes and also many other activities of daily life. The strand in the palm is a thickened connective tissue and not a tendon.
The cause is unknown, but it is mentioned in connection with metabolism and alcoholism. The disease is very similar to the plantar fibromatosis (see www.halluxvalgus.at / OP hindfoot).
Treatment
Conservatively, X-ray irradiation and stretching exercises are tried. Semi-conservatively, collagenase can be injected, an enzyme that dissolves connective tissue. Thereafter the finger is stretched by force on the next day. The fingers let themselves get stretched then, but the thick strands do not disappear.
The surgery does both: The skin is opened with a zigzag incision and a cut to the folds and skin-lines follows, to avoid future shrinkage.
Results
The hand is ready for use again after around 3 to 4 weeks. Relapses (recurrence of the contracture) unfortunately occur occasionally.
Complications
Sometimes one strand grows directly into the skin and the skin must be partly removed together with it. This sometimes extends the healing considerably, because the skin must then be sealed scarred.
A case:
Left: Prior to surgery: retracted fingers, thick strand.
Center: Immediately after the operation: The incision is easily visible. The finger is already fully stretched.
Right: After 5 months: Full stretching is for easy, the scar is gone.