Dupuytren's disease, called palmar fascia contracture, is a disease of collagen under the skin. This collagen undergoes hypertrophy and shortening, which is manifested by impaired mobility of the fingers and often visible subcutaneous thickening. The disease does not cause pain. Men over 50 are most at risk of falling ill, and women less often.
Patient J.B. aged 69, presented to an orthopedist due to increasing deformity of his right hand.
“I am a carpenter, now retired - but sometimes I do various jobs in my plant, help my son and sometimes train employees. For 3-4 years I have noticed that something is happening to my fingers in my right hand. First, a lump appeared on the side of the palm - like a hard scar just under the skin. It wasn't painful, it ran to the 4th finger, but it gave no restriction to moving the fingers.
As time passed, I noticed that the 4th finger begins to curl and it is more difficult to straighten it, and the thickening, scar becomes more and more distinct. However, the hand still remained operational and I was able to continue working. I tried to massage it and stretch it, but with little success. Approximately 2 years after the first symptoms, a second thickening reaching the fifth finger appeared. At the same time I had more and more difficulties with extending my finger IV.
This scared me a bit because I didn't think that this disease could grow and involve other fingers. I thought it was the result of various injuries or cuts that are very easy to get into in a carpenter's job. I decided to show it to my son and together we decided that it is necessary to go to the orthopedist for a consultation. There I found out that it is Dupuytren's disease - a genetic disease, and only surgical treatment. "
The patient was diagnosed and treatment was offered - surgery is the standard treatment for Dupuytren's disease. Its scope may vary: from a relatively simple needle fasciotomy to the surgical method of extensive excision of the contracted bands of the palmar fasciotomy. The needle fasciotomy procedure unfortunately causes frequent and quick relapse, extensive surgical procedures are associated with a stay in the hospital and often with a long period of healing and convalescence. Hence, the decision about the method of treatment is not easy for the patient.
"I was wondering what decision to make, it is difficult -I live far from the city, when the hand is after the operation, it will be difficult to get bandages etc. I was afraid of this procedure and put off my decision. The hand was more and more troublesome - the contracture concerned the fourth and fifth fingers - other people noticed my problems - for example, when greeting me, they were surprised that I only gave two fingers. I had difficulties with everyday activities such as washing, shaving, etc.
To my horror, I noticed that similar changes start in the other hand. Something had to be done, the decision about the procedure became more and more real. One day my son called and said he had found information on the internet about a new treatment for Dupuytren's disease. He found a doctor who uses this method and we made an appointment. "
Currently, widely used in the USA and Western Europe, the method of treating Dupuytren's disease consists in administering a preparation containing the enzyme collagenase to the contracted bands of the palmar fascia, which dissolves the collagen bands responsible for the formation of contractures. It is a minimally invasive technique that can be used in an outpatient setting.
"The doctor introduced us to the method of collagenase treatment. He stated that my changes qualify for such treatment. He informed me about the course of treatment, possible complications and costs. We have to think and choose the possible date of the procedure. "
The procedure of administering collagenase in Dupuytren's disease is performed on an outpatient basis, but in accordance with the sanitary regime of the operating room. They are often One-Day Surgery Units. After the initial qualification, the patient is scheduled for a specific date - a drug is ordered for him, which must be delivered and stored in appropriate conditions; temperature from 2 to 8 degrees C. After admission to the ward and establishing a medical history, the doctor examines the patient again, informs about the diagnosis, possible and alternative methods of treatment, foreseeable effects of treatment, including complications, and the consequences of discontinuing treatment, on this basis the patient gives written consent to the proposed treatment. The disguised patient goes to the operating room, where, after preparing and covering the operating field, the doctor performs 2 to 3 injections of collagenase into the strands of the contracted palmar fascia. This procedure does not require anesthesia. After the procedure, a dressing is put on and the patient goes home. He reports back after 24 hours.
"Together, we decided to undergo the collagenase treatment. I will stay with my son for these few days. We came to the One-Day Surgery Department at a specific time - the formalities were short-lived. The doctor described my condition and introduced itconsent to the procedure to be signed.
I have to admit that it was a difficult moment, because the possible complications mentioned in it may be worrying, but this is a standard procedure and the patient must be aware that this is a medical procedure and that potentially anything can happen - the risk is always there. I agreed and signed. We act. The procedure itself, to my surprise, was almost painless - three small pricks - like a wasp bite in the hand. A dressing, a request not to move your fingers at home, recommendations to wait another hour after the procedure in the clinic and that's all for today - I was completely surprised - how? That's it? "
The second stage of treatment occurs after enzyme incubation - that is, at least 24 hours after administration. Again, in the operating room, this time after local or regional anesthesia, a reduction procedure is performed - tearing the contracted strands apart.
"At home, I felt that my hand was swollen - so hard, it hurt a bit, but after taking painkillers it gave way. I didn't move my fingers, although I was tempted to check that they were straightening. We returned to the clinic. After changing clothes in the operating room - unpleasant hand anesthesia - sticking the needle in from the palm side and the feeling of pushing out, but apparently tearing the strands is painful, so it has to be done. The hand looked strange - considerable swelling, bruising and slight hematomas in the area where the collagenase was administered. After 15-20 minutes, the doctor started to edit - first he put his hand on such a roller (rolled bandage), and then, starting with the second finger, he gradually massaged the skin and straightened the fingers - when straightening the fourth and fifth finger I heard and felt a crunch - such a "crack ", Maybe three times. Nothing hurt.
When finished, the doctor showed me his hand - the IV finger was almost straight and the V finger was completely extended. The doctor told me to bend and straighten my fingers myself - everything worked as it should. The skin looked disheveled, swollen, bruised, there were some 1 cm cracks in it. - but I heard that the same will heal quickly. Dressing, discharge and home - check in two days. "
After correction of the contracture, if necessary, change the dressings until the wound is completely healed. In the case of secondarily contracted joints - rehabilitation and exercise are recommended. Occasionally, an orthosis that keeps the toes in extension may be used for a period of 1 month.
“At home, after the anesthesia was over, my hand ached, I had to take painkillers. But as time went on, the symptoms decreased. After two days, a change of the dressing - the swelling is clearly noticeablehas reduced and the wounds are almost healed. I move my fingers easily - it hurts a bit when I try to fully straighten it, but the effect, compared to the original state, is amazing. I'm going home tomorrow. I'm still exercising. Control in 1m-c. "
It should be remembered that not every finger dysfunction will mean making a diagnosis, informing the patient about the diagnosis and prognosis, possible and alternative treatments, predictable effects of treatment, including predictable complications, and its omission. Only on this basis, the patient will be able to consent to the optimal, according to the doctor and the patient, method of treatment.