What is Dupuytren's disease?

This is a nodular thickening of the palmar aponeurosis leading to flexion contractures of the fingers at the metacarpophalangeal joint (MCPJ) and/or proximal interphalangeal joint (PIPJ) of the fingers. The ring and little fingers are most commonly affected. The condition has a higher prevalence in people from northern European descent.

What conditions are associated with Dupuytren's disease?

This condition is mainly idiopathic and familial (autosomal dominant), however there is a high incidence in epileptics on phenytoin and is also known to be associated with diabetes, alcoholic cirrhosis, AIDS and pulmonary tuberculosis.

What other associated clinical manifestations of Dupuytren's disease do you know?

• Thickenings on the dorsum of the fingers (Garrod's pads)

• Thickening of the plantar fascia of the feet

• Thickening and fibrosis of the corpous cavernosum of the penis (Peyronie's disease)

What are the surgical options in treating the condition?

• Fasciotomy: Release of the contracture without excising the thickened bands.

• Fasciectomy: Excision of all diseased bands contributing to the deformity.

• Dermatofasciectomy: As above with the addition of a full-thickness skin graft to an excised skin defect.

• Amputation: May be necessary in severe recurrent disease.

Briefly discuss how you would perform a Dupuytren's excision

Position This is supine with the affected arm on a supporting table. The hand and forearm are then prepared and draped. The arm is exsanguinated and a tourniquet is applied.

Incision: A zigzag or Brunner incision is made from midpalm proximal to the contracture and into the finger. Skin flaps are then carefully raised.