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It is a surgical procedure used to treat a chronic condition of the hand, which causes retraction of the superficial palmar fascia, along with deformity and progressive flexion of some fingers, thus compromising mobility and the development of the basic functions of the hand.

The signs of the disease are manifested by a painless thickening and retraction of the fibrocartilaginous tissues, which are found under the skin of the palm of the hand, extending slowly and progressively, in the form of a fibrous cord towards the fingers, mostly annular and pinky finger. As the disease progresses, these fibrous cords contract, causing permanent flexion of the fingers toward the palm of the hand, causing severe functional limitations.

Dupuytren’s contracture is more common in men than in women and usually occurs after 45-50 years old. In approximately 40% of patients, the involvement can manifest bilaterally (both hands). Although the origin of the disease is unknown, it is confirmed that there are factors that increase the risk of triggering it, such as:

• Diabetes.
• Stress.
• Epilepsy.
• Smoking.
• Alcoholism.
• Hereditary factors.
• Immunological factors.
• Repeated microtrauma to the hand.

When is surgery an option?

Surgical treatment is considered the most effective when Dupuytren’s disease is already in very advanced states of contracture. This option is intended to recover the functionality of the hand, leaving the minimum possible aesthetic consequences.

There are different techniques with which to carry out the surgery, the choice of one or the other will be conditioned by:

• The level of pathology involvement.
• State of the skin of the hand.
• The general condition of the patient, age, profession.
• Mastery of the technique by the surgical team.
• Technique.

Open surgery technique

Among the most widely used is selective palmar fasciectomy (open surgery technique), performed with a transverse incision in the palm of the hand that can be prolonged based on the extent of the pathology, towards the area of the affected fingers with a small zic-zac, following the lines of the skin to avoid retractable scars.

Through it, avoiding injury to neighbouring structures (nerves, vessels), surgical resection will be performed to remove the thickened pathological tissue (fascia) and thus be able to release the tendons, restoring mobility to the fingers.

The wound will be closed with intradermal suture (trying to make it as aesthetic as possible)

Anaesthesia: it will be carried out with loco-regional anaesthesia, and ischemia control (tourniquet).

Surgery duration: Between 40 – 60 minutes.

Analgesia: This is a painless procedure, but a post-surgical analgesic regimen will be established on demand.

Admission: Between 12 – 24 hours (sometimes it can be carried out under a major outpatient surgery regime).

Recovery Phase: Between 4 – 6 weeks (it will vary depending on the degree of involvement).

Incorporation into working life: it will depend on the type of work to be performed.

When is it indicated?

The surgery will be carried out by prescription, after ruling out less traumatic treatments, if:

• There is a degree of digital deformity (severe), which prevents or limits the patient from carrying out their daily tasks.
• Retraction causes painful episodes.
• The thickening compromises the surrounding structures, causing secondary atrophies.