Surgical treatment of Dupuytren's disease
Dupuytren's disease is a benign connective tissue disease of the hand. It causes lumps to develop in the connective tissue of the palm. These lumps cause the tissue to tighten and pull the fingers inwards. This bending of the fingers is called a contracture. The condition is caused by collagen cords forming under the skin, most commonly in the little finger or ring finger. A tight contracture makes it difficult to use the hands normally.
Dupuytren's disease is most common among men. It is also more common among older men. The typical patient is a man over 60, but the disease also appears in younger people and women. Patients in the latter groups often have a genetic disposition for the disease, and may suffer from a more aggressive form, where the collagen cords develop more quickly.
Dupuytren's disease is traditionally treated with surgery, which is performed by a hand surgeon. Follow-up treatment in the form of physiotherapy and occupational therapy is usually also required. Surgery does not cure the disease; new collagen cords may continue to develop.
Besides the traditional surgical treatment, we also have access to a more recently developed, less invasive, injection treatment (Xiapex treatment). The active substance is collagenase, which breaks up the collagen fibres in the cord. When injected into the contracture cord, it weakens and dissolves the cord so that the fingers can be straightened.
The treatment is performed over two consecutive days. On the first day, the physician administers the Xiapex injection. After 1-2 days, the fingers are straightened out under local anaesthesia. In particularly advanced cases, a second injection may be required about a month later. This new form of treatment eliminates the need for postoperative care of a relatively large surgical wound.