Question

CASE STUDY 2 Sven is a 62-year-old dairy farmer. He has been diagnosed with Dupuytren's disease. The disease has pro- gressed to the point where Sven is unable to use his right hand effectively to connect the milking machine to his cows. He has put off surgery as long as possible, but now the inevitable has arrived. 1. What is Dupuytren's disease? 2. What procedure will be necessary to treat Sven's condition? 3. Can Sven expect to regain full function and normal appearance? 4. Using prior knowledge gained from previous chapters and the current chapter, why is a tourniquet used for this procedure? What will be used to exsanguinate the limb prior to inflation of the touriquet?

Answer 1

1.Dupuytren's disease is a condition that affects the fascia, the fibrous layer of tissue that lies underneath the skin in the palm and fingers. The fascia thickens, then tightens over time. This causes the fingers to be pulled inward, towards the palm, resulting in what is known as a "Dupuytren's contracture." In some patients, a worsening condition can interfere with hand function, making it difficult for them to perform their daily activities. When this occurs, there are nonsurgical and surgical treatment options available to help slow the progression of the disease and improve motion in the affected fingers.

2. At present,  there is no cure for Dupuytren's disease; however, the condition is not dangerous.

Nonsurgical Treatment

Steroid injection: Corticosteroid are powerful anti-inflammatory medications that can be injected into a painful nodule. The injection may slow the progression of a contracture. The effectiveness of a steroid injection varies from patient to patient.

Splinting: Prevent the progression of a finger contracture. Forceful stretching of the contracted finger may not be helpful and, in fact, could cause an injury to the finger or hand.

Surgical procedures: Most commonly performed for Dupuytren's contracture are,

• Fasciotomy
• Subtotal palmar fasciectomy

3. Improved movement in their fingers after surgery. However, because the condition is not "cured" with surgery, about 20% will experienc a meaningful degree of contracture recurrence. Additional surgery may be required for some conditions.

4. The treatment, other than percutaneous fasciectomy, is an outpatient operation performed with the patient under regional or general anesthesia. If local anesthetics are used, they are used without epinephrine, and an arm or forearm tourniquet is essential.