(du-pue-trahn’z) is confined to Caucasian races & is most common in northern Europeans or those of northern European descent. The predisposition to Dupuytren’s diseases is genetically inherited & much more common in men than women. Usually women develop the disease later in life with slower disease progression. Disease incidence is greater in epileptics, alcoholics & those with chronic lung disease. In the course of the disease scar tissue is laid down by scar producing cells at variable levels under the skin on the palm side of the hand &/or sole side of the foot. The scar tissue is initially evident as hard nodules palpable under the skin surface that do not affect range of motion. Longitudinal bands of scar tissue into the fingers or toes form over time & eventually begin to contract pulling the digit down into a flexed position. A strong predisposition is present in those with many family members having the disease, disease onset at an early age, severe disease, disease on the backs of the hands & feet or disease recurrence soon after surgical treatment. In very severe disease the scar tissue can choke off blood supply to the overlying skin making it more susceptible to trauma & infection.
The disease can progress more quickly after trauma which stimulates scar formation such as surgery. Additionally, inactivity allows the scar tissue to pull the digits into a flexed position unopposed.
There is no known cure because it is virtually impossible to remove or control all scar producing cells in the area. Treatment is palliative & involves surgical removal of the scar tissue. It is usually reserved for those unable to place a hand palm downward flat on a table top. If the finger still cannot be straightened after scar removal the joint ligaments &/or skin have shortened from prolonged fixation in a flexed position. It is better to address this with postoperative splinting & hand therapy than to release the joint ligaments surgically. Those with a very strong predisposition are probably better off with removal of the overlying skin with the scar tissue & replacement of this skin with full thickness skin grafts. Since Dupuytren’s disease does not occur under skin grafts (for reasons not completely understood) this is a much better option than repeat surgeries for recurrent disease. Multiple surgeries for recurrent disease can result in loss of blood supply & the need for digit amputation.