Dupuytren Foundation

Procedures

Closed cord rupture (traumatic rupture: 9149987, 7725907, 6707501 - Not recommended! )

Cortisone injection has a specific action on Dupuytren's nodules 12074617. It helps shrink and soften nodules 3973122 and may slow the progression of the disease 11119679,1769995 but does not relieve contracture.

Collagenase Injection 8724485, 12239666, 10913202, 10050246

"Enzymatic fasciotomy" - high recurrence rate 1624874

Fasciotomy 6884846 Leaving the fascia rather than excising it does not increase the chance of recurrence 10566136. Active disease regresses after fasciotomy releases the cord tension 1402277.

• Closed - for isolated MCP contracture 3171286
• Percutaneous (needle aponeurotomy is a type of percutaneous fasciotomy) 11496606, 11496607, 9972651, 8054928, works best for isolated MCP contractures 6747419.
• Minimal incision 11026201
• Z-plasty without fasciectomy 3437199 has been recommeded for single ray involvement 6692058.
• Fasciotomy and ("firebreak") skin graft 1769995, 1712163, 6380478.

Fasciectomy

• Segmental (AKA segmental aponeurectomy) 11469840, 8982932 , 1960488, 1960487, 11469840
• Partial (AKA Skoog, selective or partial aponeurectomy) appears to give as good results as total aponeurectomy, with fewer complications 9214276, 6676345.
• Complete (AKA Total Fasciectomy or Radical Aponeurotomy) 3570750 reported to have lower recurrence 2442921

Dermofasciectomy and skin graft: Lower recurrence rate compared to fasciectomy reported 6379077, although debated 7521655. Indicated for small finger PIP joint contractures 7521655, 3913679, in patients with Dupuytren's diathesis 6099169, recurrence or diffuse skin involvement 9149986, 7952813, 3908602, 7071229. Recurrence may occur beneath a skin graft 1705135.