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Dupuytren’s Disease
Dupuytren’s disease is a condition where scar-like tissue forms just beneath the skin of your fingers and the palm of your hand. Over time, this fibrous tissue can contract and force one or more fingers to curl up into the palm. This is known as Dupuytren’s contracture.
Dupuytren’s Contracture is a condition where the fingers are stuck in a bent or flexed position. While the exact cause of this in unknown, some risk factor like smoking, liver disease, diabetes, alcoholism, and others have been cited. Small nodules develop beneath the skin, eventually making it impossible for the fingers to straighten out.
Treatment typically involves the injection of a corticosteroid into the area, as well as physical therapy. There are other means of therapy that are used as well. A specialist with experience dealing with Dupuytren’s Contracture should be consulted if you are having issues or symptoms similar to what has been described.
Fasciectomy
Fasciectomy (say "fash-ee-EK-tuh-mee") is surgery to cut out a layer of tissue called the fascia (say "FASH-ee-uh") that lies deep under the skin. In Dupuytren's (say "duh-pwee-TRAHNZ") contracture, the fascia of the palm of the hand becomes thick and tight. This causes the fingers to become stiff and to curl toward the palm. Removing the fascia can help relax the fingers.
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Your hand and fingers may be swollen for the first few days. Most people need pain medicine for about a week after surgery. You may feel numbness or tingling near the cut, called an incision, that the doctor made. This feeling will probably start to get better in a few days, but it may take several months to go away. Your doctor will take out your stitches about 2 weeks after your surgery.
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How soon you can return to work depends on your job. If you can do your job without using the hand, you may be able to go back in 1 to 2 weeks. But if your job requires you to do repeated finger movements, put pressure on your hand, or lift things, you may need to take 6 to 12 weeks off work. Your doctor can help you decide how much time you will need to take off work.
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An important part of recovery is hand therapy. Work with your physiotherapist or occupational therapist and practice hand exercises at home to help your fingers become more flexible. Hand therapy may also help prevent future problems. Most people need to do hand therapy for several months. You also may need to wear a hand splint for 6 to 12 weeks after surgery.
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After surgery and hand therapy, your hand and fingers should be more flexible. Many people get better without any problems. But it is possible that the fascia may become thick and tight again. Even if this problem comes back, it is usually not severe enough that another surgery is needed.
Xiaflex®
XIAFLEX® is a prescription medicine used to treat adults with Dupuytren’s contracture when a “cord” can be felt. XIAFLEX® is injected directly into the cord that is causing your finger to be bent.
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XIAFLEX® should be injected into a cord by a specialized surgeon who is experienced in injection procedures of the hand and treating people with Dupuytren’s contracture. XIAFLEX® can cause serious side effects such as tendon rupture or ligament damage.
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How XIAFLEX® works
The enzymes in XIAFLEX® may break down the collagen in the cord. At a follow-up visit 1 to 3 days after the injection, if you still have the cord, your surgeon may try to extend the finger to "break" the cord and try to straighten your finger. Your surgeon may use local anesthetic during this procedure.