Dupuytren’s contracture

The condition is inherited as an autosomal dominant trait and is more common in males, with age, smoking, pulmonary tuberculosis, epilepsy, acquired immunodeficiency syndrome (AIDS) and alcoholic cirrhosis. It is usually found in those of Anglo-Saxon descent. Myofibroblasts in the palmar fascia proliferate and contract. Initially, there is a nodular swelling in the palm. The overlying skin then puckers. Cords running into the fingers contract causing a flexion deformity of the metacarpophalangeal and proximal interphalangeal joints. The skin over the back of the proximal interphalangeal joints may thicken (Garrod’s knuckle pads — Fig. 30.17) and a few patients may have thickening in the penis (Peyronie’s disease) or on the sole of the foot (Ledderhose’s disease).

Surgery is advised if the deformity is a nuisance or if the deformity is rapidly progressing, especially at the proximal interphalangeal joint where it soon becomes irreversible. During surgery, care must be taken to avoid the neurovas­cular bundles. Z-plasties can provide extra skin but occasion­ally full-thickness skin grafts are needed. The palm wound can be left open — it will heal rapidly with dressings. Surgery is not curative and recurrence is very common.