What is Dupuytren’s disease?
Dupuytren’s disease is a benign disease of the connective tissue of the palm, which can occur in families. This leads to a strand-like hardening and shrinking of the tissue, often insidiously over years and occasionally also in phases. As a result, the ring and little fingers can usually no longer be stretched. The cause of the disease is so far largely unexplained. A targeted therapy or prevention is therefore not possible.
If a single strand is easily accessible, it can be cut with a needle via a small puncture. Extensive tissue hardening and pronounced stiffening require a good overview in order to protect the adjacent small nerves and blood vessels. Therefore, the operation is performed with the help of magnifying glasses and in the absence of blood. Through a carefully selected access in the area of the cord, the diseased tissue is gradually loosened and removed using a microsurgical technique. Good aftercare is of utmost importance to restore mobility.
How can you prepare for the procedure?
- All your questions about possible complications of surgery for a present Dupuytren’s disease and alternative treatments should be answered in advance.
- Keep nicotine & alcohol consumption to a minimum!
- Blood-thinning medication must be taken at least once a day. 10 days before the hand surgery after consultation with your attending physician. These include, for example, ASS or Thomapyrin®.
- Discontinue vitamin preparations (A, E) as well as food supplements (omega-3 fatty acids, St. John’s wort preparations, etc.) at least 4 weeks before hand surgery.
- Surgeries limit your ability to travel by air. Therefore, do not plan any air travel in the 6 weeks following the surgical intervention, neither for business nor for pleasure!
- Have ice cubes or cooling pads ready at home to cool the skin after the surgical procedure!
How is the procedure performed?
- The cutting of the strands is done on an outpatient basis, under local anesthesia and takes 5 to 10 minutes.
- The removal of the strands is usually performed on an outpatient basis, but in the case of pronounced findings, it is performed on an inpatient basis. This is done under general anesthesia or arm anesthesia and takes about 30 to 120 minutes, depending on the number of fingers involved.
What do you need to keep in mind after the procedure?
- Elevating and cooling the hand is immensely important in the first 72 hours.
- Hourly complete fist lock as well as finger extension exercises should also be performed several times. It is very important that all joints are moved many times an hour and to their full extent. Over-the-counter ibuprofen, diclofenac, or acetaminophen tablets can be taken for pain-free exercise if needed. Please always follow the package insert!
- Postoperative clinical controls are recommended on the 3rd postoperative day and after 1 and 2 weeks.
- The skin threads are removed after 10 – 14 days.
- Independent massage of the scars from the 3rd postoperative week onwards with moisturising ointment (e.g. Bepanthen® Wound and Healing Ointment, Linola® Fat Cream) results in inconspicuous, soft scars.
“We provide you with extensive expert knowledge so that we can work with you to select the best possible treatment path.”
Dr. med. Stéphane steel is the former director of the Clinic for Plastic, Reconstructive and Aesthetic Surgery / Hand Surgery at the Lüdenscheid Clinic. Dr. Stahl studied medicine at the Universities of Freiburg and Berlin. In 2011 he passed the European and 2012 the German specialist examination for plastic and aesthetic surgery. Further specialist qualifications and additional qualifications followed (including quality management, medical didactics, physical therapy, emergency medicine, laser protection officers, hand surgery) as well as prizes and awards. In 2015 he completed his habilitation in plastic and aesthetic surgery in Tübingen. He is an experienced microsurgeon, a sought-after expert and a regular speaker at specialist congresses. After a multi-stage selection process, Stéphane Stahl became a member of the American Society for Aesthetic Plastic Surgery (ASAPS), one of the world’s largest and most influential specialist societies for aesthetic surgery. His authorship includes numerous articles in respected peer review journals and standard surgical textbooks.