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Dupuytren’s contracture

Progressive palmar fascia thickening that results in tethering, fixed finger flexion and skin puckering.

Associations

  • Family history
  • Liver disease/alcohol
  • Antiepileptic drugs
  • Diabetes mellitus
  • As a feature of other collagen tissue disorders: Peyronie’s disease (curvature of the penis), Ledderhose disease (callus under foot ± toe curling), Garrod’s disease (dorsal knuckle pads)

Clinical features

  • Fixed flexion of fingers (especially little and ring fingers)
  • Thickened palmar fascia
  • Positive table top test (functional test)

Management

  • Non-surgical
    • Conservative management if not limiting function
    • Splinting and physiotherapy 
    • Corticosteroid injections
    • Collagenase injections (collagenase enzymes break down collagen)
  • Minimally invasive
    • Needle aponeurotomy (parts of contracted cord weakened by needle manipulation)
    • Percutaneous fasciotomy (parts of contracted cord weakened by multiple incisions)
    • Segmental aponeurotomy (segments of contracted cord removed by small incisions)
  • Surgical (open)
    • Partial fasciectomy (diseased fascia removed)
    • Dermofasciectomy (skin also removed and replaced with skin graft) – lowest recurrence rate↘

Complications

  • Recurrence (50%)
  • Bleeding
  • Scarring
  • Infection
  • Neurovascular complications
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