Treatment for Dupuytren’s contracture

The main aim is to rupture or remove the Dupuytren’s bands.

Various forms of treatment can be carried out in people with Dupuytren’s contracture of increasing severity. The more extensive forms of surgery carry progressively higher risks of complications, such as nerve damage, stiffness of the fingers, infection or scarring.

Needle fibrotomy, also called needle fasciotomy

This is a simple treatment that can be used in mild or severe cases of Dupuytren’s contracture.  A needle is used to release the fibrous bands that keep the fingers in a hooked position. The doctor then straightens your fingers (the local anaesthetic will stop you feeling any pain). This releases the remaining fibres so that you can flex and extend your finger normally. This does not require a stay in hospital so you can return to work the next day.

Open fasciotomy

The surgeon makes an incision into the palm to get direct access to the thickened connective tissue. Small cuts and slits are made in the tissue to release it, and then the incision is closed. This is done under a local anaesthetic as a day case operation. Recovery takes longer than after a needle fasciotomy.

Partial or complete fasciectomy

The objective of this operation is to remove the thickened and fibrous connective tissue from inside the palm. It is a more extensive form of surgery done when Dupuytren’s contracture is more severe, or has recurred after having a fasciotomy. It is done under general anaesthetic. A partial fasciectomy involves removing only the fibrous connective tissue while a complete fasciectomy removes the healthy tissue around it too, so that there is less chance that symptoms will return.

Dermofasciectomy

A complete fasciectomy can be so extensive that the skin of the palm needs to be removed as well. The operation then becomes a dermofasciectomy, which involves grafting skin from another part of the body to replace that removed from the palm.

Injections with collagenase, An enzyme extracted from the bacteria Clostridium histolyticum.

Collagenase extracted from Clostridium bacteria breaks down the excess connective tissue that forms in Dupuytren’s contracture. You can have as many as 3 injections, each a month apart.This treatment is fairly new to the UK, having only been approved since 2011, and the long-term effects will not become clear for some time.

Radiation therapy

The National Institute of Clinical Excellence (NICE) has said that radiation therapy may be used in some patients with very mild Dupuytren’s contracture, but that there is not enough evidence to show that it can really be effective. They do, however, agree to it being an option for people unable or unwilling to have surgical treatment.

Rehabilitation after treatment for Dupuytren’s contracture

Even the most successful treatment is not a quick fix. Some surgeons recommend splints to straighten the fingers after treatment and you are likely to need physiotherapy and to do exercises to increase the flexibility of your fingers for up to six months to get the best results.