Dupuytren's Contracture


Note: I do not know or recommend the surgeon mentioned in this article. All readers who wish to obtain advice or arrange a consultation should make arrangements only after consulting their own medical advisers and obtaining their approval. I have included details merely for convenience and not as a recommendation.


***



In Dupuytren's Contracture (also known as `old man's claw hand') the little finger and ring finger turn into the palm and cannot be moved. A few months ago a reader, Lord Walsingham, sent me a copy of an excellent paper he had written entitled `The Case of Lord Walsingham's Hands' and I am delighted to have the opportunity to refer to it. Lord Walsingham reports that tens of thousands of British patients are subjected to surgery every year for this condition - and that the surgery is estimated to cost in the region of 2,000 per case - and tells me that he had his Dupuytren's Contracture dealt with by a surgeon in Paris. The operation (needle fasciectomy) is not done in the UK but according to Lord Walsingham it is effective, painless and cheap. It involves a local anaesthetic, takes around twenty minutes and costs 30.

In contrast, the type of surgical procedure popular in Britain puts the hand out of action from four to eight weeks and can cause post operative discomfort which `can last for months or even years'. The doctor Lord Walsingham recommends (and although I have not seen the doctor at work I have seen photographs and I found Lord Walsingham's evidence convincing) is Docteur Jean Luc Lermusiaux who works just outside Paris.

I have studied a paper published by Dr Lermusiaux and four colleagues (published in the Revue du Rhumatisme in December 1997) and I am impressed. The procedure makes good sense.

The technique used involves cutting the fibrous bands which produce the deformity with the needle which is used to inject a local anaesthetic - instead of using a knife - and the authors claim that the outcome is similar to that of surgical fasciectomy (the type of operation usually favoured - which involves a hospital stay). At least one fairly large trial has been performed and the results seem extremely convincing. Moreover, the French surgeons who perform this operation claim that serious adverse experiences are uncommon. Recurrences can occur but they can also occur with traditional surgery.

`Needle fasciectomy is a low cost procedure that requires no hospitalisation, absence from work, rehabilitation therapy or nursing care,' conclude the authors, who also point out that: `This type of surgery should only be performed by practitioners who have extensive experience with the method and in-depth knowledge of the anatomy of the hand.'

In a way it is appropriate that the French should have found a new and better way to treat this problem. Dupuytren's Contracture is named after Baron Guillaume Dupuytren (1777-1835) who first described it and who was French.

Some readers may be surprised to learn that a surgical procedure which is available in France is not available in the UK.

However, it is not at all uncommon for surgeons to continue to perform unnecessarily expensive, complicated, time consuming and hazardous operations despite the existence of operations which may be safer, faster and more effective.

Maybe a few British surgeons will investigate this technique and consider adding it to their repertoire.

Meanwhile, a reminder to all readers: before undergoing any surgery it is always wise to check that there are no better types of operation available.


Note: I do not know or recommend the surgeon mentioned in this article. All readers who wish to obtain advice or arrange a consultation should make arrangements only after consulting their own medical advisers. I have included details merely for convenience and not as a recommendation.
Update 16th August 2007
I am delighted to report that I have been informed that there are now some surgeons and clinics outside France using this technique. Check with your national society offering advice to patients with Dupuytren's Disease for more information.

Copyright Vernon Coleman 2003
back