Dupuytren disease is a systemic disorder which most visibly affects the hands. Currently, there are treatments for hand deformities caused by Dupuytren disease (“Dupuytren contracture”), but no treatment for the underlying process of Dupuytren disease. The goal of the Dupuytren Research Group is to develop a medical treatment of Dupuytren disease.
Treatments of Dupuytren contracture fall into two categories: surgical and minimally invasive. Treatments improve some or all of the deformity. These improvements usually last for years, but may not be permanent. Contractures developing after treatment are either called recurrence (return of the original contracture) or extension (contractures affecting new areas). Both recurrence and extension are common after treatment.
Surgical treatments involve making a cut or cuts in the skin in the affected areas of the palm and fingers. The tight, diseased tissues under the skin are either released with a cut (fasciotomy) or removed (fasciectomy). In severe cases, portions of the palm skin are also removed and replaced with skin graft (dermofasciectomy). The cuts may be sewn closed or left open to heal on their own. All of these variations are planned ahead of the time by the surgeon. Fasciectomy is currently the most common treatment performed for Dupuytren contracture.
Minimally invasive treatments involve releasing the tight tissue under the skin without making a cut in the skin with a knife. Tissue can be cut beneath the skin with the tip of a small hypodermic needle (needle aponeurotomy) or weakened by injecting collagenase enzyme (Xiaflex®, Xiapex®) into the cord beneath the skin. After either approach, the surgeon pulls on the finger(s) to rupture the cord and straighten the finger. Minimally invasive procedures are most often performed in the surgeon’s office under local anesthesia. Collagenase injection is the second most common treatment performed for Dupuytren contracture in the United States.
The choice of procedure is personal. Surgical treatments, on the average, last over twice as long as minimally invasive treatments before return of contracture. However, surgical treatments have a higher complication rate and longer recovery time than minimally invasive treatments. There’s no perfect choice. Since the early 2000s, there has been an increasing trend to choose minimally invasive treatment as the first treatment. Surgical treatments are recommended for people who have more severe contractures, who have predictors of aggressive disease (onset younger than 50, knuckle pads, Ledderhose disease, family history of Dupuytren disease), or those with early/multiple recurrence after minimally invasive treatment.
Catch-22s of treating Dupuytren Contracture
Radiotherapy for Dupuytren disease