Surgery for Dupuytren's disease

The origin of Dupuytren's disease is as yet unknown; all that is known is that it is partly genetic, and that several members of the same family may suffer from it. The disease affects the aponeuroses, tissues whose role is to protect muscles, nerves and vessels. At the onset of the disease, they thicken to form nodules, or balls, which cause folds in the fingers or palms, then retract, forming flanges in the hands, a kind of cord that limits the fingers' ability to extend. This can lead to the fingers being enclosed within the palm. Usually affecting the fourth and fifth fingers, it can extend to all the others. It usually causes no pain.

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It presents in variable forms. Patients with the most severe forms may be carriers of similar diseases affecting the soles of the plants, the sex for men, and the backs of the fingers. It generally appears around the age of 50 for men, and later for women. Although manual labor is not the cause of this disease, certain accidents can develop it; it is also preferentially associated with several illnesses: diabetes, epilepsy, hypertriglyceridemia, alcohol consumption, smoking.

At present, there is no drug treatment available. The only possible treatment is the sectioning or removal of diseased tissue, but this surgery cannot prevent the disease from developing, spreading to other fingers, or even recurring on the operated fingers. This is why early forms of the disease are rarely treated, but severe forms should not be delayed, as this can make treatment more difficult and risky. In particular, if treatment is delayed too long and the finger joints are stiff, it may be impossible for the surgeon to extend the fingers. Results are also poorer when the fifth finger or finger joints are affected preferentially. As a general rule, treatment is recommended when the patient can no longer place his or her hand flat on a table by pressing down with the other hand. A painful, swollen hand, with perspiration followed by stiffness, is a worrying pattern.

There are three main groups of treatments, depending on the severity of the disease and the patient's individual case. Complications arise from the fragility of the skin and its proximity to nerves and blood vessels. After-effects may include residual pain, stiffness in the fingers, wrist or shoulder.
The first is the simple cutting of bridles with the tip of a scalpel or the bevel of a needle. The first technique to appear chronologically, it is simple and allows rapid use of the hand. In many cases, an orthosis - a device designed to extend the finger - will have to be worn for several weeks. This procedure can damage vessels, nerves or tendons. It is not indicated for all patients, but preferably when the flange is superficial, under the skin. The recurrence rate is higher than for other techniques.
The second is the removal of bridles, a surgical procedure lasting between 30 minutes and 2 hours, generally under local anaesthetic and without systematic hospitalization. Three weeks are needed for the incisions to heal, and they will remain thick for several months. When the surgeon leaves part of the scar open to avoid complications such as haematomas, healing takes longer but is less painful. Among the risks, a nerve or artery may be severed; persistent tingling, sometimes lasting several months, may be the result of nerve irritation; fingers may remain stiff. Orthoses and rehabilitation are necessary.
The third is the removal of flanges and skin with a skin graft, a more ambitious and time-consuming technique, with few recurrences but greater aesthetic sequelae. This procedure is reserved for severe forms or the treatment of recurrences. Complications are similar to those of simple flange removal, and healing is lengthy.

In the event of surgery, the patient must be off work for at least a month. All treatment must be tailored to each patient's particular case, depending on the severity of the disease and the specific forms it takes in each individual situation.

The price for this type of intervention varies between 100 and 300 euros. The mutual insurance company may reimburse part or all of the excess fees.