Current treatments

Surgical and non-surgical options

There is currently no cure for Dupuytren’s disease, but for patients with Dupuytren’s contracture there are a variety of surgical and non-surgical treatments available.1,2,3 Timely medical intervention can prevent progression of contracture and permanent damage to the hand.4 People with Dupuytren’s contracture should be reviewed on a case by case basis and treatment must be discussed with a doctor.

 

Non-surgical treatments

 

Collagenase clostridium histolyticum is a non-surgical approach in which enzymes (called collagenases) are injected directly into the cord. These enzymes dissolve the collagen to break down the cord. The injection is followed by a procedure the next day during which the finger is extended by the doctor, breaking the cord. In some cases, the cord breaks on its own so the extension procedure is not needed. This treatment does not require the patient to stay in hospital. Anaesthetic is not needed for the injection, although local anaesthetic may be used for the extension procedure.5

Another non-surgical treatment option is percutaneous needle fasciotomy, a technique which uses a needle to cut the cord. The needle is inserted into the palm or fingers to cut (section) the tissues in the palm. The Dupuytren’s cord is sectioned by moving the needle in a sawing motion. This movement is repeated several times. The aim is to break the cord so the finger can be straightened. This technique can be carried out under local anaesthetic and may be performed in a day surgery or doctor’s office without any need for a hospital stay.6

Radiation therapy a further treatment which is usually used for patients who are in the early stages of the disease. The goal is to prevent, or at least delay, the need for surgery. The affected hand is placed under an x-ray or electron beam machine and then radiation is applied to the lumps in the palm. This is repeated over several consecutive days.7

Non-surgical options

 

Surgical treatments

 

For patients with Dupuytren’s contracture, corrective surgery is the mainstay of treatment.3 It is usually performed when contracture of the metacarpophalangeal joint (the joint closest to the palm) is more than 30 degrees or when there is a 15 degree contracture of the proximal interphalangeal joint (the middle joint halfway down the finger).8

Fasciectomy is a treatment option that involves surgery during which the whole of the cord is removed (rather than cut). The cord can be removed in three possible ways:4 

  • Limited fasciectomy: the affected tissue (the cord) is removed and the wound is then stitched up and dressed.
     
  • Radical fasciectomy: all the connective tissue is removed and the wound is then stitched up and dressed.
     
  • Dermofasciectomy: all connective tissue (including the skin) is removed and the wound is then sealed with a skin graft.
     

Fasciotomy is another procedure where a surgical cut (called an incision) is made into the hand.
A surgeon then uses a scalpel to cut the cord. Afterwards, the wound is stitched up and dressed. This procedure is generally performed under local anaesthetic in a day surgery or doctor’s office without any need for a hospital stay.4

Surgical treatments

 

 

References:

  1. Hurst LC et al. N Engl J Med. 2009;361:968–979
  2. Gilpin D et al. J Hand Surg. 2010;35A:2027–2038
  3. Bayat A and McGrouther DA. Ann R Coll Surg Engl. 2006; 88:3-8
  4. Townley WA et al. BMJ. 2006;332:397-400
  5. Xiapex Summary of Product Characteristics.
  6. NICE guidelines. Needle fasciotomy for Dupuytren´s contracture. 2004
  7. NICE guidelines. Radiation therapy for early Dupuytren´s disease. November 2010
  8. Rayan GM. Bone Joint Surg. 2007;89(1):190-198