Dupuytren’s contracture is a fairly common disease. Although it is generally a painless disorder, it can significantly impede a person from performing his daily tasks. There are plenty of approaches used to treat the disorder. If detected early enough, the contracture may be treated with conservative measures. These measures may include any or all of the following: injecting with collagenase preparations, undergoing physical and occupational therapy, and undergoing radiation therapy. However, some cases of Dupuytren’s contracture may require the patient to undergo an operation. Here are the various surgical interventions that may be used to treat Dupuytren’s contracture:
5a. Needle Aponeurotomy
Needle Aponeurotomy, also known as Percutaneous Fasciotomy, is a minimally invasive surgery that may be used to treat the disease at its earlier phases. Once local anesthesia has been administered to the patient, the surgeon uses a very thin, sharp needle to weaken the cord that causes the finger/s to bend towards the palm. He does this by inserting the needle under the skin to cut through the cord. Because the cord has already been weakened, it is easily snapped or ruptured when the doctor straightens the patient’s finger/s. Although it corrects the problem, Needle aponeurotomy does not remove the diseased or pathological tissue. This surgical intervention can be done in the physician’s office or clinic setting.
There are plenty of advantages of using this procedure to treat the contracture. For starters, it isn’t as invasive as other surgeries so the complications after the treatment are minimal, if any. Recovery and return to normal activities are faster, and it can be done to those who have other preexisting health problems that might make general anesthesia operations too dangerous. However, since the pathological tissue isn’t removed and can continue contracting, recurrence is a great possibility. Other risks include the formation of hematomas, infection, and injuries to the nerves.
5b. Palmar Fasciectomy
Palmar Fasciectomy is the removal of the palmar fascia, or the pathological layer of fibrous tissue in the palm. It can either be total or partial palmar fasciectomy, with the latter as the preferred technique. The duration of the operation may reach up to 90 minutes. It may also be done under either local anesthesia (numbs the hand without putting you to sleep) or general anesthesia (you’re put to sleep).
After the anesthesia has been administered, the surgeon will clean the skin of your palm with the appropriate solution to make sure that it is free of germs. He will then make an incision in the skin, which will probably be along the natural lines and creases of your hands. This way, the scar won’t be so noticeable after the hand heals.
After the incision is made to expose the palmar fascia, your doctor will cautiously separate the diseased tissue from the surrounding anatomy such as tendons, arteries, and nerves so as to avoid inflicting damage on these nearby structures. The surgeon will then remove enough of the pathological tissue to allow your fingers to be straightened completely. He might also have to release contracted or stiffened joint ligaments or joint capsule, especially if the patient took a long time before seeking medical intervention. Skin grafts may also be performed. Finally, the surgeon sews the skin together using fine stitches.
Since palmar fasciectomy is a major procedure, complications (nerve and blood vessel damage, reactions to anesthesia, etc.) may arise. Rehabilitation takes longer than the minimally invasive approach. What’s good about it, though, is that recurrence rates are lower.
Surgeries for Dupuytren’s contracture are aimed at restoring the hand’s former level of functioning. Although none of the operations are guaranteed to totally cure the disorder, these interventions have proven useful in improving the quality of life of patients experiencing such condition.