WHAT IS DUPUYTREN’S DISEASE OR CONTRACTURE?
Dupuytren’s contracture is a fibro proliferative disease of the palmar fascia, capable of producing a disabling flexion contracture of one or more fingers, progressive and irreversible nature. It has not yet come to fully understanding the exact cause of this proliferation of fibrous tissue and, therefore, the etiology of the contracture. The only consistently effective treatment is surgical excision.
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The disease has been associated with
- Epilepsy: in patients with prolonged treatment with phenobarbital
- Diabetes: related to the duration of this, the incidence rises to 80% in patients over 20 years of evolution.
Clinical signs are more common on the middle finger instead of the little finger. His appearance is mild, with only thickening of the palmar fascia, rather than contraction. It is said that alcoholism may be predisposing factors, dyslipidemia, smoking, liver cirrhosis, chronic lung disease, tuberculosis, trauma or recurrent micro trauma.
There is general agreement that the only effective treatment for Dupuytren’s contracture is surgery, which always keep in mind that the disease may recur if not fully removed the diseased tissue and in some cases surgery may worsen. There are three types of operations: fasciotomy, fasciectomy regional and radical or extensive fasciectomy, which are indicated, not by the presence of the disease, but by the severity of the contracture and joint involvement.
The primary goal of surgery is to improve functional capacity, reduction of the deformity and decreased recurrence. The 2 surgical principles are the longitudinal strain relief and proper handling of the skin.
You must raise the member within 48 hours to prevent swelling, stiffness and reflex sympathetic dystrophy.
During the first 2 days hand is raised and performs a bulky compressive bandage, with or without a ferrule, to keep the hand in operating position.
From the second day and into the second week, apply a light dressing with stimulation and early mobilization of the fingers.
20% of surgical patients present complications. The more radical the procedure, the more likely complications occur. These fall into two groups:
- Early: hematoma, skin loss, infection, nerve damage or digital artery, and edema
- Late: loss of flexion or rigidity of the more common after radical excision of recurrence and reflex sympathetic dystrophy is five times more common in women.