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Dupytren's Disease

Why does it occur?
There is a strong genetic component to developing dupytren's disease. Other risk factors are diabetes and excessive alcohol intake.

Symptoms and examination
Patients notice thickening of the skin in the palm and fingers and this causes the fingers to roll into the palm.

Treatment
If the thickening is minor and the deformity of the fingers is mild the disease can be observed. If the hand cannot be placed flat on the table treatment can be considered. The type of treatment depends on the severity of the disease. At shoulderelbowhand we tailor your treatment to your symptoms.

Minimal Invasive Treatments

Collagenase / Xiapex
This is a new drug that has been released for the treatment of Dupuytren's disease. It is an enzyme that dissolves the collagen in Dupuytren’s disease. The drug is called Xiapex and contains purified collagenase clostridium histolyticum. When injected directly into a Dupuytren's cord, it enzymatically disrupts collagen. As a result of collagen disruption, the contracture may be released and the fingers straighten. This is performed as an out patient procedure with the patient awake. It is a new treatment and your doctor will explain the pros and cons of this procedure and if you are suitable.

Needle Fasciotomy
This can be performed with the patient awake under local anaesthetic. A needle is placed through the skin into the Dupuytrens disease and the needle used to divide the disease at multiple points. Once these weak areas have been created a gentle manipulation is performed to straighten the finger. The advantage is that it is performed without a general anaesthetic and no incisions are made in the skin. The recovery is quicker than open surgery and the risks reduced. Not all dupuytrens disease is suitable for this type of treatment and your specialist will asses if this is suitable for you.

Open Surgery

This is usually performed under general anaesthesia or regional block (injection in the arm pit which makes the arm numb). It is usually performed as a day case procedure. Surgery is performed through zig zag incisions and the Dupuytrens disease is removed. Care is taken not to damage the nerves that supply the finger. The skin is sutured with fine stitches and dressing applied.

LINKS
http://orthoinfo.aaos.org/topic.cfm?topic=A00008

http://www.dupuytren-online.info/

http://dupuytrens-society.org.uk/ 

Mr Sameer Singh's specialist areas