Dupuytren's disease
By multiplication of the fibrous tissue torsels and subcutaneous tumors arise. The torsels generally lie in the hand palm and can contract as a result of which the fingers will take a curved position. These torsels mimick tendons but that’s not wat they are. The torsels can occur principaly in the whole handpalm and in all fingers. The cause is not yet clear.
Surgical treatment of the Dupuytren’s disease is done by means of several incisions through which the damaged tissue is removed. Surgical treatment is however no guarantee that the disease will not come back. After the operation also other parts of the hand can be damaged. It may therefore be that several operations are necessary.
Reasons to operate are pain on the spot of the torsels and tumours, abrogations of the skin and a curved position of the fingers. If a finger has been curved for a long time it is possible that the finger will not get entirely straight after the operation.
At each hand operation complications can occur such as bruises, slowed down wound cicatrisation, infection and necrosis. The sensory nerves of the fingers can become damaged at surgical treatment and a partial loss af feeling may follow.
A not much attentive complication in hand surgery is dystrofy. The symptoms are a combination of pain, swelling, discoloration and stiffness of the fingers which appears after the surgical treatment. This condition must be treated early before function impairments will occur.
After a hand operation it may be necessary to add fysiotherapie and/or a rehabilitationprogram.
Prior to the intervention,
the future scar has been outlined as a sigsagline. The sigsagline is
meant to ensure that shrinking of the scar that always occurs, will not
lead again to a bend position
of the finger.
After opening the skin the fibrous tissue is outlined
with a dotted line. The operation is done
in a bloodless field by squeezing the blood out of the arm prior to operation
and preventing the blood to flow to the arm
by means of an inflated cuff around the upper arm. In this way the surgeon has
a good
visibility and is able to recognise the structures
well, for instance the small
nerves that go to the fingers.
Another example. To ensure that the fingers do not return automatically in the old bend position, a plaster of Paris or a special brace is frequently given for the duration of 2-3 weeks.
In the foot the same disease is possible. Then it is called Morbus Ledderhosen. A thickening of the fascia plantaris is present that can cause pain while walking. An example of the disease and therapy (total excision) is shown.
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