Dupuytren's contracture is a progressive disorder that affects the palmar fascia, causing the fibrous tissue to shorten and thicken, which may prevent full extension of the hand and limit function.
To justify the risks of surgery a flexion deformity must be present.
Procedure may be carried out under GA or LA depending on severity of contracture.
Referral to secondary care
NHS Vale of York CCG does not routinely commission surgical treatment for Dupuytren’s contracture.
Referral for surgery should only be considered when the patient meets at least one of the following functional difficulties:
- Metacarpophalangeal joint contracture or proximal interphalangeal joint contracture of 30 degrees or more at least in one joint (inability to put hand flat on table)
- Patient under 45 years of age with disease affecting 2 or more digits and loss of extension exceeding 10 degrees
- All additional risk factors for aggressive progression are present, specifically - bilateral disease, family history of condition, ectopic lesions, age under 50 and male gender
- there is significant threat to hand function
- surgery is likely to restore function
Treatment in all other circumstances is not normally funded and should not be referred unless there is prior approval by the Individual Funding Request Panel.
Patients who are not eligible for treatment under this policy may be considered on an individual basis where their GP or consultant believes there is an exceptional clinical need that justifies deviation from the rule of this policy. Individual cases will be considered by the individual funding request panel.
To submit an application to the CCG's Individual Funding Request Panel, please click here for further information.
Please click here to view the full Dupuytren's Contracture Commissioning Statement.
Please click here to view the referral form.
Patient Information Leaflets (PILs)
Dupytrens Contracture Patient Information Leaflet: click here
|Policy date: September 2016||Next Review date: September 2018|
|©NHS Vale of York Clinical Commissioning Group|