Dupuytrens Disease

This common condition of the hand starts with pitting and nodule formation in the palm.  The nodular areas may progress over time, leading to cord formation and ultimately flexion contractures of the digits. The ring and little fingers are most commonly affected. There is rarely any significant discomfort although palmar nodules can be tender. The underlying tendons, nerves and blood vessels are unaffected. It is estimated that the condition affects 3-5% of the population, mainly owing to a genetic predisposition although there are other known associations such as recurrent hand trauma, diabetes, alcohol intake, antiepileptic medication and smoking.

There is no cure for Dupuytren’s disease and the rate of progression is highly variable. In early disease, treatment options such as corticosteroid injection, radiotherapy and splinting lack supporting evidence and are therefore not offered. Non-surgical treatment includes enzymatic degradation of the diseased cords, using Collagenase within a trial setting (DISC Trial).

The mainstay of treatment is surgical with percutaneous, open division (fasciotomy) or complete excision (fasciectomy or dermofasciectomy) of involved tissues. Full thickness skin grafts may be required to close the resulting wound. Fasciotomies can be performed in a clinic setting under local anaesthetic for patients with mild digital contracture or patients not fit for general anaesthesia. More extensive procedures usually require a general anaesthetic or regional block and recovery is prolonged but associated with lower recurrence rates. All Dupuytren’s operations can be carried out as day case surgery with post-operative splinting and hand therapy arranged. Patients will require at least 2 weeks off work.

NHS Lothian currently has a virtual triage pathway for Dupuytren’s referrals requiring photography and survey submission.  Patients are then directed down a clinic or operative visit.