Needle fibrotomy for Dupuytren’s contracture

Dupuytren’s contracture is a condition in which excess connective tissue forms in the palm, causing some of the fingers to become permanently contracted. Treatment using the needle fibrotomy technique is a simple walk-in, walk-out treatment that is highly effective, as Dr Christopher Rowland Payne, Consultant Dermatologist at The London Clinic, explains.

Dr Rowland Payne is an experienced dermatologist who qualified in the late 1970s after completing his medical training at St Bartholomew’s Hospital and at the University of London. He has held key dermatology posts at leading institutions during his career, including the Université de Paris, where he was Professeur Universitaire. He has practised at The London Clinic since 1995.

He treats the full range of skin conditions, including benign and malignant tumours, eczema, acne and psoriasis and offers a full cosmetic dermatology service. He has a special interest in the non-surgical treatment of patients with Dupuytren’s contracture by needle fibrotomy.

Dupuytren’s contracture

Dupuytren’s contracture leads to a build-up of abnormal connective tissue within the palms, which makes it increasingly difficult to straighten the fingers.

“Once Dupuytren’s has begun, the finger will gradually curl into the palm; this may happen over a number of years or even in a few months. This then decreases the manual dexterity of the patient.”

The underlying cause of the condition is not fully understood but a gene mutation is suspected and a region of chromosome 16 has been identified as the part of the genome where the Dupuytren’s gene mutation lies. This explains why the condition runs in families.

“The susceptibility is known to be autosomal dominant, which means that you only need one copy to develop the condition. It therefore has a 50 % chance of passing from parent to child. It is particularly common across Northern Europe, Scandinavia and Iceland, where the disease affects as many as 4 in 10 men over 70.”

Part of our Viking heritage

“Dupuytren's contracture occurs exclusively in people of Viking descent. If you draw a map of the world and use it to plot the prevalence of Dupuytren’s and the places where the Vikings went, the 2 maps are very similar.

The underlying molecular mechanism is complex and is still the topic of research but cells within connective tissue called myofibroblasts are thought to become abnormal, forming material that is only capable of contracting. The process is considered by some experts to be an over-zealous attempt at wound healing.”

Needle fibrotomy: a walk-in, walk-out treatment

Dr Rowland Payne is a leading UK expert in needle fibrotomy, a minimally invasive treatment for Dupuytren’s contracture that can be done as an outpatient procedure under local anaesthetic.

“Often, a patient with Dupuytren’s contracture can come into my consulting rooms at The London Clinic for half an hour and leave with their fingers straight.”

How does needle fibrotomy work?

Needle fibrotomy aims to introduce weaknesses into the problem tissues, allowing them to be broken by gentle manipulation.

“A good analogy is a strip of stamps, which are joined together by perforations. When pulled apart, the stamps separate easily at the perforations.

This is exactly how needle fibrotomy works. Under local anaesthesia, the Dupuytren’s bands are perforated with a fine needle. Then the fingers and hand are stretched. The bands rupture at the perforations and the hand straightens. The whole procedure takes a matter of minutes and the patient can drive home and go back to work the next day.”

Our goal is a good outcome for each patient

“We recently sent a questionnaire to patients who had experience of both surgery and needle fibrotomy. Nine out of 10 patients preferred the needle technique.”

Needle fibrotomy can be done before, after and often instead of classical surgery.

“In cases of Dupuytren’s contracture in which open surgery is required, I work very closely with orthopaedic and plastic surgeons. There are occasions when I ask them to help and vice versa.”

A link with skin cancer

“Our data at The London Clinic has demonstrated that patients with Dupuytren’s contracture may have a higher than normal risk of developing skin cancer. We have found that around 30 % of patients with Dupuytren's contracture also have skin cancer. Routine total skin examination of Dupuytren’s contracture patients often reveals coincidental skin cancers that had not been noticed before.

I am an advocate of total skin examination and offer this to all patients who come to see me. It enables many skin cancers and other diverse and treatable problems to be discovered far earlier than they otherwise would.

This is not only true for patients with Dupuytren’s; it also applies to patients seen for other skin conditions. Several years ago I published a series of 102 patients with melanoma; in 30 of them their melanomas had been discovered by a routine total skin examination done during an appointment for something completely different. Total skin examination is an effective way to detect skin cancers early; it allows prompt and timely treatments and it saves lives.”

Dr Rowland Payne's profile