Dupuytren's disease Discussion

The natural history of Dupuytren's disease is progressive contracture of the skin and soft tissues of the palm. This may result in progressive joint contracture, inability to lay the hand flat on a table, onset of pain or other change in behavior of the thickened tissue. Conservative treatment is ineffective in the long run. Surgical excision or release is the most reliable current treatment. The main risk of conservative treatment is progression of the contractures to the point that they can not be corrected. Surgical treatment has definite risks which include numbness, stiffness, pain, tender scars and possible vascular compromise resulting in amputation. Other risks include infection, hematoma formation, wound healing problems and residual contracture. Extensive zigzag incisions are usually required, and skin grafts and local flap coverage may be needed. Therapy is required postoperatively for range of motion, splinting and wound care. Full patient cooperation with therapy is essential to achieve the best result possible. Therapy may be needed for months and night splinting is mandatory for months to help prevent recurrent contractures. True recovery time after Dupuytren's surgery is approximately one year, making this a complicated and extended process. An average of one third of patients will ultimately develop significant contractures following surgery, from recurrence at the operative site or secondary disease elsewhere in the hand. Isolated proximal interphalangeal joint contractures, on the average, regain only half of their lost motion following surgery. No guarantee can be given regarding appearance, function or end result, and it is possible to be worse off after surgery if complications occur.

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