Treatment Options for Dupuytren's Contracture
Living with one or more bent fingers can make life challenging, affecting the ability to do even the easiest of tasks —brushing teeth, opening jars, putting on gloves. Now, there are several options for people with bent fingers due to Dupuytren’s contracture. These include both surgical and minimally invasive procedures, all of which can straighten fingers for many years.
Two Dupuytren’s contracture procedures have become common in recent years, particularly in patients with milder or more moderate contractures. They offer advantages over surgery, such as lower complication rates and recovery times (up to two weeks), plus much less physical therapy or time off work. The downside is the recurrence rate. The minimally invasive procedures are usually less effective than surgery, with earlier reappearance of contractures. Repeat of the procedure is possible, however.
- Needle aponeurotomy (also called needle fasciotomy). Your doctor uses a sharp needle to painlessly penetrate the dense fascia, which sits just below the skin on your palm. With Dupuytren disease, the fascia has become thick, creating a cord that exerts pressure on your fingers causing them to bend. The needle can pierce the cord, breaking it up so your fingers can lie straight. The procedure is done under local anesthetic. Doctors must be specially trained to do this procedure. Its risks include minor nerve or tendon injury, infection, pain and numbness.
- Dupuytren's contracture injection. An enzyme called collagenase clostridium histolyticum (brand name Xiaflex) is injected into the cords of your hand. It is an in-office procedure. Over the next 24 to 72 hours, the enzyme works to soften or, in some cases, dissolve the thick, tight cords. Afterwards, you go back to the doctor, who—with a local anesthetic—manually moves your fingers open. This procedure is easier for doctors to learn and perform. It does carry some risks including damage to tendons, ligaments or nerves, as well as the potential for allergic reaction; however, those are rare. Common side effects are swelling, bruising, bleeding and pain.
Open surgery or fasciectomy is the most common way currently to treat Dupuytren’s contracture. It keeps the recurrence of contractures at bay much longer than with the minimally invasive procedures (one study showed only about half had recurred 10 years after surgery). However, surgery also has significantly longer recovery time and higher complication rate, especially as a repeat procedure. Surgery tends to be reserved for more severe or advanced cases.
- Fasciectomy. Performed with either general or a local anesthetic, the hand surgeon makes a cut in your palm and divides the cords of tissue. Usually you are able to go home the same day. Recovery time is 1 to 3 months and you’ll need physical therapy. Risks of the surgery include bleeding, numbness and infection. There's also a chance the contracture can worsen, causing loss of function in the hand.
- Dermofasciectomy. Besides the fascia, this procedure removes the skin above it. That means you’ll need skin grafts on top of the excision site, requiring an extended post-surgical recovery and physical therapy). This surgery is usually reserved for severe cases.
After you have surgery or the needle procedures, you may have to have a cast or a light splint on your hand for a while, especially while sleeping, and do hand exercises. Sometimes massage, along with heat application, is necessary after surgery to help keep the fascia from re-thickening and re-forming cords. This prevention process, however, may ultimately be limited by the chronic nature of Dupuytren disease.