Fibrous thickening in hand and fingers leading to contracture of fingers - Myofibroblast cells are activated, concentrate in nodules proximal to joints and lay down collagen matrix. Coordinated contracture of the myofibroblasts shorten the matrix and cause the contracture

Indication for surgery: Once one is unable to place the affected fingers flat on table

Operation - Fasciectomy and Z-plasty

Surgery - this is preferably performed under general anaesthesia; takes on average about 30-45min for a typical case

Longitudinal incision along the length of contracture. Duputyren's nodule resected. Care taken to avoid the digital nerve and artery. Z-plasties to pull in surrounding skin and lengthen residual scar.

Postop - the hand will be in a bandage, elevate the hand in a sling when not using it, remove bandage after 1-2 weeks. Stitches used are usually dissovable - will come off 1-2 weeks after the bandage is removed

Risks

Recurrence - 10% 3 years

Nerve injury - numbness, loss of sensation(from damage to digital nerve - especially if there is a spiral band of Dupuytren's curling around nerve or in recurrent cases)

Wound problems - breakdown/slow healing, infection(report to doctor immediately if there is increasing pain or smell in wound)

Bleeding, impairment of blood supply to finger(rarely, risk of finger loss)

Pain in scar/wound, swelling of fingers; chronic/severe pain(complex regional pain syndrome)

Persisting contracture/stiffness of joint(esp if longstanding Dupuytren's) - Not being able to fully correct the contracture with the surgery

Other Alternatives for treating Dupuytren's contracture 

1. Needle Fasciotomy(Percutaneous or Open )- dividing the bands with needle(high risk of recurrence - 70% at 3 years); good especially if on long hospital waiting list). If mulitple fasciotomy being done - can be done in theatre. Some inject Kenacort A10 into the broken bands

2. Observe - for early Dupuyren's where there is not yet any fixed flexion deformity

3. Collagenase injection(Xiaflex) - This is an enzyme derived from the bacteria Clostridium histolyticum that breaks up collagen. Convenient option for those who cannot have surgery. Disadvantages - higher relapse/recurrence rate compared with surgery(35% at 3 years). Risks include injection site damage(bleeding/bruising, pain/tenderness, swelling/oedema, skin tears esp if band adherent to skin, tendon rupture, nerve damage, complex regional pain syndrome), rash, pruritus, development of antibodies to collagenase, lymph node swelling, anaphylaxis. Will not release joint fixed contracture.  

4. Radiotherapy 

5. Future therapy - Anti-TNF agents to inhibit the myofibroblasts (ongoing research at present)