Overview
Dupuytren's contracture (also known as 'claw hand') is a type of hand deformity that often occurs in the elderly. The contracture causes a gradual knotting of tissues found in the palm of the hand, which eventually form thickened tissue structures that can pull one or more fingers inward, eventually forming a deformity of the hand that makes simple tasks such as writing or buttoning a shirt extremely difficult.

According to the Mayo Clinic, Dupuytren's contracture generally affects the outside fingers of the hand, and may take months or years to develop. The cause of the condition isn't known, but is believed to be a form of autoimmune reaction.

Who Benefits from Dupuytren's Contracture Surgery?
Anyone who has been diagnosed with Dupuytren's contracture may benefit from surgery to help relieve the stiffening of fingers that make shaking hands, cooking or driving difficult if not impossible. While the disease progresses very slowly and causes no pain for many individuals, such as not always the case. 

Nonsurgical Treatments for Dupuytren's Contracture
A variety of treatments may be utilized to relieve the contracture, including needling, a procedure that involves the insertion of needles through the skin into the thick bundle of knotted tissue affecting the contracted finger, but such procedures must be repeated on a regular basis.

For others, enzyme injections which have recently been approved by the Food and Drug Administration (FDA) may help reduce the rigidity of the corded tissues that develop in the palm of the hand. However, as with needling treatments, enzyme injections offer only temporary relief.

Dupuytren's Contracture Surgery Basics
The goal of surgery is to straighten bent fingers and restore mobility and function that offers greater mobility. For some individuals, skin grafts in the area near incisions to the finger being straightened may offer additional flexibility and long-term function.

Surgery for Dupuytren's contracture may last between one and two hours. The patient is placed under general anesthesia or may only require a local anesthetic, determined by the surgeon. An incision is then made in the palm of the hand, often along the crease to reduce scarring.

The surgeon exposes the Palmer Fascia, the major bundle of fibrous tissue found in the palm of the hand beneath the fingers and above the wrist joint. The Palmer Fascia attach skin and muscles to underlying bone structures. The surgeon will then remove or scrape away a portion of the Palmer Fascia until the affected finger or fingers are able to straighten.

Following the severing of the Palmer Fascia, the surgeon will sew the skin together.  A skin graft may be necessary in the event that the fingers or palm cannot relax or open flat following the procedure.
 
Most individuals will need physical or occupational therapy to help restore movement and mobility in the affected area. The length and effectiveness of physical therapy will be determined by how much scar tissue built up and the severity of the contracture.

How Much Does Dupuytren's Contracture Surgery Cost?
Cost for Dupuytren's contracture surgery will depend on a number of factors, including the technique used, the type of anesthesiology, the severity of the contracture, and the need for physical therapy following surgery. In the United States, surgery for Dupuytren's may cost between $3,000 and $5,000, while individuals traveling to locations such as Singapore or India may receive the surgery at substantial savings.

Who Performs Dupuytren's Contracture Surgery?
An orthopedic or plastic surgeon may perform Dupuytren's contracture surgery. Plastic surgeons should belong to accredited organizations or so associations in their country of origin and have completed at least five years of surgical training, with two years in plastic surgical techniques and procedures. Trained and experienced orthopedic and general practitioners may also perform various techniques and procedures. Always verify the training, education and certification of any surgeon, and make sure he or she belongs to reputable Orthopedic or Plastic Surgery organizations or associations in their country of origin.