Dupuytren's disease Discussion
The natural history of Dupuytren's disease is progressive contracture of
the skin and soft tissues of the palm. This may result in progressive joint
contracture, inability to lay the hand flat on a table, onset of pain or
other change in behavior of the thickened tissue. Conservative treatment is
ineffective in the long run. Surgical excision or release is the most
reliable current treatment. The main risk of conservative treatment is
progression of the contractures to the point that they can not be
corrected. Surgical treatment has definite risks which include numbness,
stiffness, pain, tender scars and possible vascular compromise resulting in
amputation. Other risks include infection, hematoma formation, wound
healing problems and residual contracture. Extensive zigzag incisions are
usually required, and skin grafts and local flap coverage may be needed.
Therapy is required postoperatively for range of motion, splinting and
wound care. Full patient cooperation with therapy is essential to achieve
the best result possible. Therapy may be needed for months and night
splinting is mandatory for months to help prevent recurrent contractures.
True recovery time after Dupuytren's surgery is approximately one year,
making this a complicated and extended process. An average of one third of
patients will ultimately develop significant contractures following
surgery, from recurrence at the operative site or secondary disease
elsewhere in the hand. Isolated proximal interphalangeal joint
contractures, on the average, regain only half of their lost motion
following surgery. No guarantee can be given regarding appearance, function
or end result, and it is possible to be worse off after surgery if
complications occur.
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