Transcript Dupuytren’s - Hand Surgery Consultant

Mr G Shyamalan (Shyam)
Hand Surgeon HEFT
So Much Choice!
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Benign proliferative disease
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Fascia of digits and palm
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Nodules, cords and contractures
Need yes to one of the questions to approve
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Moderate MCPJ contracture >30 degrees
Any PIPJ contracture
First web contracture
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Age
Ancestry
Sex
FH
Diabetes
Smoking and Alcohol
Epilepsy
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Trauma
Surgery
Diabetes
No FH
Any race
Generally non-progressive
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Male
<50
Affected siblings/parents
Ectopic Disease ‘Garrod’s pads’
Bilateral Disease
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1.
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Do nothing
Radiotherapy – early disease
Steroid Injection
Percutaneous Needle Fasciotomy
Collagenase/Xiapex
Limited Fasciectomy
Dermato-fasciectomy and skin graft
Amputation
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1. Do nothing £0
2. Radiotherapy – early disease £2500 (10
visits)
3. Steroid Injection (£ Steroid vial +OPD)
4. Percutaneous Needle Fasciotomy (£ OPD
+needle +/- theatres)
5. Collagenase/Xiapex (£760 per vial/digit)
6. Limited Fasciectomy (£2500 plus therapy)
7. Dermato-fasciectomy and skin graft
(>£3000 plus therapy)
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1. Age/Retirement
2. Occupation
3. Hand Dominance
4. Pain
5. The speed of progression of disease
6. Recurrence Vs Extension
7. Extent of contracture PIP joint
8. Diathesis (bilateral, radial side, male)
9. General Systemic Health
10.Patient expectations
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Triamcinalone
50% softening
50% recurrence one year
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Mostly clinic based
Splint 6 – 12 weeks at night
Low complication rate
Early return to work
5% early failure – akin to a failed injection for
CMC joint arthritis!
Long-term 50% recurrence in 5 years but not
always requiring surgery
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Good option for early rehabilitation
Less time off work
Less recurrence than needle release
Recurrence rate akin to surgical fasciectomy
Has side effects as a drug (see next slide)
Side Effects
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Paraesthesia ,Complex regional pain syndrome (CRPS)
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Hypoaesthesia
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Monoplegia
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Burning sensation
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Tremor
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Lymphadenopathy
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Crepitus
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Arthralgia
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Hyperhidrosis
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Myalgia /Muscle weakness and spasm
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Wound dehiscence
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Joint swelling
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Tendon rupture
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Injection site reactions
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Ligament injury
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Ecchymosis
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Procedure with known results
Good for limited disease
Can be performed under local anaesthesia
Recurrence rates higher than skin grafts
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Lowest recurrence rate
Best choice for young patient
Increase time to wound healing (diabetics and
smokers take longer)
Longer rehabilitation time
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Extent of the pre-surgical contracture of the
finger
Longer you live, the higher the recurrence!
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Refer early
Tailor treatment to patient
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[email protected].
uk
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[email protected]
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