Dupuytren's contracture is a thickening of the palmar aponeurosis. This condition leads to impaired mobility of the finger joints. It is a common disease that affects up to 3% of the population. Two-thirds of the sick experience difficulties with professional activities, and some people become disabled. You can undergo your treatment of Dupuytren's contracture in Germany to restore your hand function and return to work. You are welcome to visit the Booking Health website to find out the prices of treatment and select a medical care program.
Content
- Conservative therapy for Dupuytren's contracture
- Minimally invasive procedures for Dupuytren's contracture
- Surgery for Dupuytren's disease
- Where to undergo treatment for Dupuytren's contracture?
Conservative therapy for Dupuytren's contracture
Treatment options for patients with Dupuytren's contracture include the following:
- Monitoring involves a medical examination once every 6 months and is suitable for people with a stable disease and preserved joint mobility.
- Physiotherapy can be used in the early stages of the disease, with ultrasound procedures being preferred.
- Bandages are used to stretch the fingers.
- Ergotherapy improves hand function.
- Corticosteroid injections are made for painful nodules. Symptoms recur in 50% of those treated, and there is an increased risk of complications, including adipose tissue atrophy, skin pigmentation, and tendon rupture.
- Radiation therapy can be used in the very early stages and is associated with a risk of complications.
- Drug therapy involves taking medicines. Cytostatics, estrogen receptor antagonists, and botulinum toxin may be effective for some patients, but drugs do not help everyone.
Minimally invasive procedures for Dupuytren's contracture
Only mild Dupuytren's disease can be treated without surgery. In other cases, the following interventions can be performed:
A needle aponeurotomy is a percutaneous dissection of the cords of the damaged palmar aponeurosis at several levels. This is an outpatient procedure performed under local anesthesia. The recovery period is minimal. The very next day, a patient can do light work, and after a week, all restrictions are eliminated.
Collagenase injections aim to destroy thickened areas with the help of enzymes. Collagenase is derived from the bacterium Сlostridium histoliticum. After the injection of the drug, cord rupture is performed the next day. The next treatment stage is immobilization with a plaster splint in the position of maximum extension of the fingers for 7 days, then for another 4 months during sleep. Collagenase injections lead to a 75% reduction in contractures, with a recurrence rate of up to 35%.
Surgery for Dupuytren's disease
Surgery may be indicated in cases of severe contracture of Dupuytren, the ineffectiveness of conservative measures and minimally invasive procedures, and disease recurrence. Doctors perform the following surgical procedures:
An open fasciotomy is an outdated operation that is not used at German hospitals but is still used in states with poor medicine. The surgical intervention involves the dissection of the palmar aponeurosis using open techniques. The disease recurs in every third patient, which is the main disadvantage of this operation.
A selective fasciectomy is the removal of part of the pathologically altered palmar aponeurosis. This is a sparing operation with a low risk of complications and the main type of surgical treatment for Dupuytren's disease in developed countries.
A total fasciectomy is a very rare operation that involves the removal of the entire palmar aponeurosis. The operation is traumatic, requires long-term rehabilitation, increases the risk of hand joint stiffness, and has a higher risk of recurrence as compared to selective fasciectomy.
A segmental aponeurotomy is a minimally traumatic operation during which one or more problematic segments of the palmar aponeurosis are removed through several small incisions. The results of the intervention are comparable to those of a selective fasciectomy.
A dermofasciectomy is the layer-by-layer removal of tissues such as skin, adipose tissue, and a cord with palmar aponeurosis. The operation is more traumatic but, at the same time, more effective. Its main advantage is a very low risk of recurrence. The mobility of the hand joints is restored. The disadvantage is the long recovery period. In addition, the operation is complex, and the cost of treatment is higher since defect repair with skin grafts is required.
Where to undergo treatment for Dupuytren's contracture?
You can undergo your treatment in Germany. You are welcome to use the Booking Health service to select a hospital. Our website presents the current cost of treatment in Germany, at which you can make a treatment appointment at the hospital for your preferred dates. Prices of treatment will be reduced by 40-70% due to the absence of additional taxes for foreigners.
Authors:
The article was edited by medical experts, board-certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
Sources:
National Library of Medicine
Web MD
