Angus Keogh Procedures – Dupuytren’s Contracture (Palmar Fibromatosis)
Dupuytren's Contracture (Palmar Fibromatosis)
This disorder is a contracture in the layers of tissue just under the skin in the hand. It is commonly thought to involve the tendons in the hand but this is not actually the case; it is simply the palmar fascia, a thin layer of fibrous tissue in the palm of the hand. If you squash the skin on your forearm, the skin moves easily, whereas the skin in the palm of the hand is stuck to material just under the skin. That is the palmar fascia. For some reason (it is partly hereditary) the palmar fascia can start to thicken and contract as we age. As a result, the fingers can start curling up. Patients don’t like the look of the curly fingers but more importantly it can be disabling. The finger can stick in your eye or catch on your pants or get in the way. Consequently, some patients seek help. From a surgical standpoint, this is only required typically when it is hard to get the hand flat on a table (Heuston’s table top test). At this stage surgery can be considered. This usually involves cutting the skin open and cutting out the diseased tissues. Sometimes skin is needed to be taken from the upper arm to replace very diseased tissue in the palm of the hand (if the skin is really badly involved). This is called a full thickness skin graft.