Palmar fasciectomy (Dupuytrens contracture)
Dupuytren Contracture
Dupuytren contracture is a palmar fibromatosis of uncertain etiology. Reports were first seen in 17th century European medical literature, well before the eponymous Baron Dupuytren, a prominent French surgeon, performed his first palmar fasciotomy in 1831. Dupuytren presented his findings at a lecture, the exact words of which were subsequently disseminated widely by his students, leading to the adoption of his name for the condition.
The syndrome is characterized by fibrosis of the palmar fascia leading to flexural contraction of the digits, which is often progressive. Both the proximal interphalangeal (PIP) joint and the metacarpophalangeal (MCP) joint may be affected. Although many cases appear to be idiopathic and without coexistent conditions, a variety of associated diseases have been reported.
Therapies include conservative medical and surgical modalities. Although the condition is not fatal, significant morbidity can occur if patients remain untreated.
For additional information, the eMedicine articles Dupuytren Contracture (orthopedic surgery focus), Dupuytren Contracture (rheumatology focus), and Dupuytren Contracture (physical medicine and rehabilitation focus) may be helpful.
Source: eMedicine - very detailed and informative article about Dupuytren Contracture ...
Dupuytren's contracture - What is palmar fasciectomy?
The usual operation for Dupuytren's contracture is called palmar fasciectomy. It involves removal of a section of the tissue (the fascia) under the skin on the palm of the hand. The operation is either performed as a day-case, or will involve one night's stay in hospital.
Palmar fasciectomy may be done under general anaesthesia, which means you will be asleep throughout the procedure. But it can also be done under regional anaesthesia, which means that you will still be awake but your hand will be numb.
Your surgeon will explain the benefits of having the surgery, and discuss the associated risks and alternatives to the operation.
Once the anaesthetic has taken effect, a tourniquet is put around the upper arm to control bleeding during the operation. Incisions are made into the affected fingers and palm. The affected tissue is removed, and the fingers are allowed to relax into their normal position.
Source: spirehealthcare.com - excellent article about palmar fasciectomy ...
DUPUYTREN'S CONTRACTURE
Dupuytren's contracture is a fibroproliferative condition that primarily affects the palmar and digital fascia and can cause contractures of the metacarpal phalangeal and interphalangeal joints of the hand.
The palmar side of the hand can be thought of as a series of layers. Most superficially is the skin. Immediately under the skin is the palmar fascia which is a thin layer of fibrous tissue. Under this layer of fibrous tissue is a layer of tendons, nerves and blood vessels. The final and deepest layer is composed of muscles and bones.
The second layer down, the palmar fascia, starts to grow in Dupuytren's disease and initially forms a painful nodule in the palm
The discomfort resolves spontaneously in several months. The fibrous tissue continues to grow and forms a pretendinous cord or hard band, detected on palpation, stretching from the palm to the base of a digit
The ring finger is most commonly affected first, followed by the small finger. The pretendinous cord can contract or shorten and cause a contracture of the metacarpal phalangeal joint (MCP). As the disease progresses, the contracture may involve the proximal interphalangeal joints and, rarely, the distal interphalangeal joints. The patient can always flex the fingers into his hand, but cannot fully extend them. The natatory cord can cause adduction of adjacent digits to the extent that they cannot be passively abducted. The inability to spread the fingers apart can cause skin maceration between the digits
A severely contracted digit greatly interferes with both hand function and such routine activities as wearing gloves. The progress of the disease can be predicted to some extent and is determined by the patient, the presentation, and the associated conditions.
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