What is it?

Dupuytren's disease (pronounced. Dipitrena) is a disease involving the overgrowth of fibrous layer called the palmar fascia, which is located under the skin over tendons and vascular elements nervously on the palms of the hand. Fascia palmaris is the spatial "scaffolding" hand.

Cause

Dupuytren's disease is a genetic disease that most likely originates from Scandinavia. It is passed down from generation to generation as an autosomal dominant trait with incomplete penetrance gene.

Symptoms

The symptom of the disease is to change the appearance of the skin and deterioration of the efficiency of his hand through a progressive contracture of the fingers. The disease manifests itself as a thickening of fascia that occur under the skin, which initially appear as single bumps. Changes in the form of beads are localized mostly on the palmar side. As the development of the disease are thickened nodules lying pulling them over your skin. Bumps connecting to cause contraction of the skin at the cola progressive bending / closing of the finger / toe. The beads may also occur on the palms of the fingers, soles of the feet and even the penis. In such cases, we are dealing with Peyroni'ego Disease.
The disease process may involve several fingers which causes a significant reduction in the efficiency of the hand. In some advanced stages of the disease using the hand it becomes impossible due to the closure of several fingers. Although the disease process often mistakenly associated with occupation tendons flexing his fingers, but the disease does not directly concern them. In some cases, oversized palmar fascia can constrict the nerves finger causing the patient Sensory disturbances on their toes. Typically, the disease occurs without pain.

Testing and diagnosis

The diagnosis is based on an interview concerning the development of the disease, places the first appearance of lumps and the dynamics of their enlargement and the progressive deterioration of the function of the hand.
Typically, the disease runs without low back though in some cases they may be accompanied by numbness on the fingers resulting from nerve compressions finger by overgrown aponeurosis. The study estimated the number of hand fingers caught up in the disease process, the degree of impairment of their function (evaluation of the deficit unbend the fingers), the condition of the skin pulls in the disease process.

Treatment

Same bead / hypertrophy palmar aponeurosis not restrictive extension of fingers is not an indication for treatment. The indication for treatment is the emergence of a substantial inability to straighten the finger / fingers.
Treatment may be inoperable eg .: (use injections that dissolve hypertrophic rozściegno .co.uk not admitted for use in Poland, cutting subcutaneous needle rozsciegna) of operational or surgical excision of hypertrophic parts rozściegna. The procedure requires a lot of experience of the surgeon and training in microsurgery because during the surgery need wypreparować involved in a disease process nerves, arteries and veins finger. Very often, you also need to free immobilized finger joints, which as a result of prolonged immobilization were stiffening. Most wound is sutured seams performing sophisticated plastics skin is sometimes necessary to apply a skin graft and in some cases the wound is not sutured at all. The surgeon may decide to use wires to keep the snap finger after cutting the patient's palmar fascia and release the contracture of joints. The wires are made for a short time. It is also possible to use the advanced equipment in order to obtain a snap finger, but they are often not used due to its cost.
The patient must also be informed that prolonged stiffening of the finger in the bent position can cause shrinkage of the arteries, veins and nerves finger / toe and it may not be getting its / their full extension. It also happens that in very advanced cases, the patient may lose a finger as a result of the ischemia.

After the surgery

After the surgery is used on the hand dressing. The surgeon may also use plaster immobilization to help keep the fingers snap required. The patient should be from the first day of the operation should practice performing flexion and especially the snap of fingers. The dressing is changed every day unless they used a skin graft if the surgeon will decide when the dressing should be changed. To reduce the pain associated with the surgery are enough "normal" drugs for pain and wearing arm in a sling. Hand, do not charge for approx. One month. The surgeon may also recommend physical therapy in a specialized rehabilitation center.
Sutures are removed at the earliest two weeks after surgery, although often the last stitches are removed until later. The patient must remember that during the operation cut is only part of rozścięgna palmar, which has sickness hypertrophy. He can always come to relapse in the place of cut or develop it in another part of town. This is due to the genetic background of the disease.