Non-operative measures such as stretching exercises or night extension splinting will not slow the progression of the disease. There is some evidence that radiotherapy may slow the progression of the disease, but this is mostly reserved for younger patients who present with early disease.
Surgery is indicated if the flexion contractures of the digits are impacting the patient’s daily activities. Surgical options to treat the disease are patient specific, as certain techniques are more appropriate for certain types of Dupuytren contracture.
Collagenase (Xiaflex®) is an enzyme that degrades connective tissue and is used in some centres overseas to treat Dupuytrens. It can be injected into the affected area and then 48 hours later the surgeon breaks the cord by stretching the finger under local anaesthetic. It is not available in South Africa.
Percutaneous needle fasciotomy is a technique where the cord is cut using the angle of a hypodermic needle but is only suitable in well-defined cords in the palm.
Open fasciectomy is the procedure that is most often performed for Dupuytrens and may be partial, complete or with excision of the overlying skin (a dermofasciectomy), although this is usually only very advanced cases.
Note, it is impossible to cure Dupuytrens by completely resecting all of the cords, so recurrence thereof is inevitable. However, the more of the disease you resect the longer the intervening period before recurrence.
After surgery the hand will be in a resting extension splint for 7 days, after which the sutures are removed and rehabilitation with an occupational therapist is begun. Rehabilitation is key in this to maintain tendon gliding and actively retain the gains made at surgery. The surrounding tissues need to be stretched and swelling and scar management is the hand therapist’s expertise, so they can be of significant assistance in this rehabilitation process.