Dupuytren's Surgery

• Video ID: pQ7QkMjAoIk
• URL: https://www.youtube.com/watch?v=pQ7QkMjAoIk
• Uploaded: 2014-12-13
• Duration: 287s
• Views at capture: 135538
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Description (channel copy)

http://www.handandwristinstitute.com/dupuytrens-contracture/ - Thickening of the fascia in the palm of the hands is indicative of a disease known as Dupuytren’s contracture. It is a genetic-linked disease that seems to primarily affect people of Scandinavian descent, but can be found in most populations. It is typified by the uncomfortable thickening of the subcutaneous tissue of the hand between the skin and the bone/muscle, especially at the knuckles and the PIP joints. While not generally painful at its outset, as it progresses it can make it impossible to extend the fingers, severely limiting mobility and the use of the affected hand.

In addition to the nodules that can form at the joints of the hands, the thickened fascia will rise up towards the skin of the palm and become visible in the form of cords. These cords extend from the palm to the joints of the fingers, and represent the most severe iteration of the disease.

It is possible to achieve some relief from symptoms of Dupuytrens by injecting a particular enzyme into the affected fascia which will disoolve parts of the built up tissue and hopefully return some maneuverability and mobility to the hand. Generally speaking, however, surgery is the only viable solution once the condition reaches a certain point.

In order to avoid scarring and possible complication, or even development of flexion after surgery, the incision is Z-shaped. Surgery is not protracted, and in three days you will have a removable brace made to hold your fingers in extension while you are not doing exercises to strengthen your grip and maintain mobility. Ten days after this, the stitches will be removed and you may get the wounded area wet. Including therapy, recovery time is about three months, and while it is unlikely you will have recurrence in the same finger, there is a 25% rate, and it IS more likely in people who have suffered from Dupuytrens before.

Transcript

Let's talk about dupetrin surgery. First, let's understand what dupetrin's disease is. Let's take a look at the overall fascia. Fascia is a lining that's underneath the skin throughout the body. And in the palm, it it extends from the from the mid palm all the way

out to the fingertips. What this does is just a thickened layer that kind of protects the tendons, nerves, and arteries of the hand. And it's in this area that dupetrins disease uh can cause this proliferation or thickening of the tend of the fascia. As you can see here

in the next image, you can see here these nodules start to form or it starts to proliferate and becomes quite thick. As you can see in the next image, it actually dupatrin starts out as just a painless nodule. Patients will come in and they feel this thickening. Uh

usually there's uh some predisposition based on kind of hereditary factors in some individuals uh usually of Scandinavian descent and they come in and they and they get this again thickening. It doesn't hurt. Occasionally it does but that usually is

self-limiting and goes away. But where it starts to become a problem is when it starts limiting the ability to extend the fingers. So initially painless nodules develop but then you start getting these cords that form and that again out into the fingers the the

fascia starts to thicken and as it does as you can see here on the top on the little finger it starts to curl the fingers down. It's more common in the little and ring fingers. Now let's take a look now at actual patient that has this again this cord starts to develop

throughout the mid palm all the way out to the past the PIP joint and it can start to draw down both the knuckle or the MCP joint and the PIP joint. Rarely it's the last joint but usually it's one of the two or both of those. So let's take a look actually at the an animated

picture. This shows the contraure. Uh and a contraure meaning that the that the finger's contracted. doesn't straighten out all the way in this case. So, it's called a flexion contraure because it's stuck in a bent position. Again, they can still bend fully and

make a full fist, but they can't straighten out. So, let's take a look now at the an actual patient that had a PIP flexion contraure. The MCP joint straightened out all the way, but there was almost a 90 degree bend at this area right here. Now, so let's take a look

now at the treatment for dupetrance disease. We're going to we're going to concentrate on the surgery aspect, but to mention there are two other common treatments many surgeons may perform in the in the office. One is an enzyme injection that there's some indications

for and a perccutaneous needle release. But today we're going to concentrate on what many surgeons still do today and that's a surgical excision of this thickened fascia. So let's take a look now at the incision. Most incisions in the in the on the palm side of the

fingers whether it's fixing a tendon that's been cut or in the case of duperrins disease we make a zigzag cut because if you make a straight incision that in itself as it heals can cause a flexion contraure of the digit. So as you can see here let's take a look at an

actual patient. You can see the zigzag incisions that have been made. There's sutures still in this patient that were used to straighten the fingers out. Uh next image we'll take a look. This is an actual healed uh after all the stitches have come out after a satisfactory

healing period. You can see a nice scar and the contraure has been relieved as the fingers are straight. Now the the as we as we'll talk about now with the recovery uh rehabilitation first let's talk I want to mention the indications for uh how how bad does the flexion

contraure need to be before you do the surgery? Well, typically it's about a 30° bend of the knuckle. So about 30 degrees of bend from straight at the knuckle or any degree of flexion contraure at the PIP joint. The PIP joints harder to get straight. So really

any flexion there is a reason for surgery. After the surgery, usually within 3 days, you come back for a posttop wound check. The the splints removed that was put on at the time of surgery and we have a removable brace made. Now, this is critical to start

bending right away because you don't want to lose the full grip that you have. But it's important to maintain with through a extension splint, holding those fingers straight when you're sleeping and when you're not exercising, but frequently taking off the brace to

do that. The stitches come out 10 days later, you can start getting it wet at that point. All in all, it's about a 2 to threemonth total recovery period. There's about a 25% recurrence rate with this disease, but over the long haul. and and in some patients they may have

more than one digit involved. In some cases you'll take it out of the little finger and the ring finger pops up a few years later. For more on this and many other conditions, please check out our website.