What is Dupuytren's Disease | London & Essex?

Profesor Ben Miranda performs Dupuytren's disease hand surgery in London Harley Street & Essex (Chelmsford & Southend). Dupuytren’s disease develops over time and affects the deep tissue (fascia) that passes from the palm into the fingers. This fascia becomes thickened into nodules  and then extends into longitudinal fibrous cords that cause the fingers to bend towards the palm (flexion deformity), and may result in permanent joint stiffness (flexion contracture). Associated skin puckering or dimpling is common early on and, while not usually painful, you may experience some level of discomfort.

Dupuytren's disease is often genetic, it is more common in males and patients living with diabetes, epilepsy or liver disease, as well as those who have injured their hands. Alcohol and smoking may also increase the risk of disease occurrance. Progression of Dupuytren's disease may be unpredictable, however, early age of onset (<50 years), bilateral hand involvement, a positive family history, or disease elsewhere such as in the feet, are associated with an increased risk of both progression and post-treatment recurrence. 

Hand surgery is the main form of treatment and timing of surgery is crucial; correct timing requires good judgement and a thorough discussion about your Dupuytren's disease hand surgery in London or Essex, between you and Professor Miranda. Nodules are generally best left alone unless they become painful and surgery should be reserved for when the fingers start to bend. It is important not to let the disease progress for too long, otherwise, if the fingers are very bent prior to surgery and have been in this position for a long time, more extensive surgery may be required; results may then not be as good as if the disease were treated earlier on.

Telephone: 020 3763 7999

Email: secretary@BenMiranda.com 

What types of Dupuytren's Disease Hand Surgery are Available in London & Essex?

Fasciotomy: This is usually performed under local anaesthetic and is a relatively minimally-invasive procedure. The fibrous cords are released via small incisions in the palm or finger using either a needle (needle aponeurotomy) or blade. This procedure may be suitable for well-defined cords, palmar involvement, mild contractures or in patients who are unfit / unsuitable for more complicated surgery. Although there is a faster recovery, fasciotomy does have complications and a higher recurrence rate than other techinques.

• Anaesthetic: Local anaesthetic.

• Surgery Time: 15 minutes.

• Hospital Stay: Day case.

• Recovery Time: 1 week.

• Time off Work: 1-2 weeks.

Fasciectomy: The fibrous cords are removed, usually under regional or general anaesthetic. The entire wound is stitched up and may have a zig-zag appearance to help lengthen the skin. Very rarely, a skin graft may be required in very advanced disease, or, a small part of the wound may be intentionally left open to heal by itself (open-palm technique); this will avoid the requirement for a skin graft and has no detrimental effect to your overall function.

• Anaesthetic: Regional or general anaesthetic.

• Surgery Time: 60-90 minutes.

• Hospital Stay: Day case.

• Recovery Time : 4-8 weeks.

• Time off Work: 6-8 weeks.

Dermofasciectomy: In some cases of very advanced disease, a portion of overlying skin needs to be removed along with the underlying fibrous cords, and a skin graft is applied to the defect. This procedure may be necessary in cases where the overlying skin is extensively affected by disease, in recurrent cases, or in young patients (20-40 years) who almost always have recurrence after fasciectomy. Dermofasciectomy is a more complicated operation with a longer recovery time than fasciectomy, however it does offer a lower recurrence rate in the previously discussed circumstances.

• Anaesthetic: Regional or general anaesthetic.

• Surgery Time: 60-120 minutes.

• Hospital Stay: Day Case.

• Recovery Time: 6-12 weeks.

• Time off work: 6-12 weeks.

What are the complications of Dupuytren's Disease Hand Surgery?

Many of the potential complications of hand surgery listed below will be minimised by Professor Miranda's clinical experience and meticulous surgical technique, careful post-operative follow-up in the dressings clinic and hand therapy rehabilitation. Whether you have your Dupuytren's disease hand surgery in London or Essex, you can rest assured that Professor Miranda and his experienced team will offer you the best care available.

Less invasive procedures such as fasciotomy have a lower risk profile compared to fasciectomy or dermofasciectomy; however, the recurrence rate is higher, sometimes quoted as being up to 80% at 2 years. Fasciectomy and dermofasciectomy recurrence rates are quoted in the region of 10-20% at 5 years. 

Other potential complications may include infection, bleeding, vessel or nerve injury (numb finger), stiffness, tendon injury, complex regional pain syndrome, compromised blood supply to the finger (more common in revision surgery), incomplete release / recurrence (more common in the middle joint / PIP joint of the finger), wound breakdown and poor scarring.