Dupuytren's contracture...

[Boerseun]

So - I had to take my dad in to hospital yesterday for surgically relieving his Dupuytren's contracture.

 

This was, by the way, the first time I've ever heard of this particular medical condition.

 

Dupuytren's contracture (also known as "Morbus Dupuytren", "Dupuytren's disease" or "Palmar fibromatosis", and sometimes misspelled as Dupuytren's constricture) is a fixed flexion contracture of the hand where the fingers bend towards the palm and cannot be fully extended (straightened). It is named after Baron Guillaume Dupuytren, the surgeon who described an operation to correct the affliction.

 

Apparently, it's caused by underlying contractures of the "palmar fascia". The ring finger and little finger are most commonly affected, whilst the rest of the hand is just fine.

 

There seem to be two solutions: Firstly, they can either cut open the palm and physically remove the contracted tissue, which allows the finger to straighten out again. Or, a second remedy is to use a needle to repeatedly puncture the contracted "palmar fascia", and then under local anesthetic, physically (forcefully) straighten the afflicted digit (literally tearing the palmar fascia open, allowing the finger to straighten out all the way. According to all the articles I found on the web, neither of these solutions are permanent, and the constricture just start all over again.

 

The thing is, with the first procedure, there's a risk of cutting the nerve. The second procedure does not have that risk, and seems to me much more sensible - especially if the procedure will most likely have to be repeated every second year or so.

 

So me and my dad discussed this all the way to the hospital, and when we got there, we agreed that his doctor might have jumped the gun a little in ordering the procedure. We turned around and went home.

 

I agree - self-diagnosis is a stupid thing to do, but hear me out:

 

According to all sites I've visited regarding Dupuytren's contracture, the surgical option is an outpatient procedure. My dad would have had to spend the night in hospital to be prepped, because he's a diabetic and they have to watch what he eats - and because of bleeding etc. he has to be under full anesthetic. All other patients coming in for this op, gets local. My dad, however, can do the needle-procedure under local anesthetic, because the risk for arterial damage is much lower.

 

All the info I've gathered regarding this condition says that it's not life-threatening in any way, and won't cause the patient to lose the use of his hands. At most, it's uncomfortable. The surgical option, however, has a 5-15% chance of cutting the nerve, which would cause losing functionality in the specific finger. If you consider that the cause of Dupuytren's contracture is entirely unknown, but they do know that surgery doesn't cure it - it merely relieves it for a year or so until the contracture starts again, it means that the procedure will have to be repeated every few years. The chance of permanent damage through surgery will then approach 1 as the years go by.

 

Surgery, to me, at least, looks like the worst solution under the circumstances. I haven't been able to track down a specialist doing the needle-thing yet, but I am looking to that as the most sensible solution.

 

So, as to my question (thanks for reading this far - I know it's a bit long-winded):

 

Do you or anybody in your family suffer from Dupuytren's contracture? Have you had surgery, or the needle-poking? How did that work out for you?

 

Any personal info will be much appreciated - I've read just about everything I could on the web.

[moondanc]

Hi there,

You ABSOLUTELY made the right decision. Open hand surgery is a huge deal-- 4-6 to maybe more months of recovery with huge complication rates.. Here's a resource for you:

http://www.dupuytren-online.info/Forum_English/board/dupuytren-0.html-- post there to find a doc in-- I think you're in So. Africa? If you want to come to the US--I can recommend the best doc in the world for NA. The website

will tell you everything you need to know about Dupuytren's and needle aponeurotomy -NA-(I've had 3 procedures and still can't spell it :-) The thing is-- your dad can keep on trying -in some people the disease comes back, in others it doesn't-- over and over before taking the huge step of open hand surgery. Also, there's a new remedy coming out-- it's a drug called collagenase or Xiaflex supposed to be approved by the US FDA in the next few months. I had the procedure in a trial and wasn't that satisfied with it but it might work for your Dad. In any case, try NA and best of luck!

 

moondanc

[Boerseun]

Thanks, Moondanc, and welcome to Hypography!

 

I feel a lot better about our decision, having another opinion. We're still searching for a doc who can do the needle thing, but funnily enough, after hearing that the contracture won't make him lose functionality in his hands, it seems to be bugging my dad a lot less.

 

Thanks for the info, I'm off checking it out right away!