Surgery for Dupuytren Contracture 

Surgery for Dupuytren Contracture 

No Results

No Results


Surgery for Dupuytren contracture generally should be performed on an affected metacarpophalangeal (MCP) joint if the contracture is 30° or greater. Such contractures most likely cause some debilitation for the patient. Usually, a limited fasciectomy of the pretendinous cord is sufficient to establish normal function in the MCP joint.

The evaluation of a proximal interphalangeal (PIP) joint in Dupuytren disease is different from that of an MCP joint, and the prognoses differ as well. In PIP joint contractures, one should clearly define the method to be used in surgery and discuss with the patient his or her expectations and occupation, as well as activities the patient engages in that may require the use of his or her hands.

Complications occur most often in patients who require total fasciectomy because of severe disease; McFarlane and McGrouther reported a complication rate as high as 17-19%. [1] During surgery, complications may include severing of the digital nerves, most often the neurovascular bundle; the inadvertent creation of a buttonhole through the skin flaps during their separation between the skin and the fascia; and circulatory compromise secondary to trauma to the digital arteries.

Postoperative complications include loss of flexion, hematoma, skin sloughing, infection, edema, and reflex sympathetic dystrophy (RSD). The most common postoperative PIP-joint complication is loss of flexion, which occurs in 6% of patients.

The triad of hematoma, infection, and skin loss occurs in 3% of patients. Hematomas most often form in the palm, and they may be prevented by meticulous hemostasis, by removal of the tourniquet before the wound is closed, and by rapid evacuation of hematomas, which prevents necrosis of tissue and skin and decreases the risk of infection. Elevation of the hand can prevent postoperative edema.

RSD more commonly occurs in patients with extensive fasciectomies and, thus, more aggressive disease. This idiopathic pain syndrome, which often occurs 3-4 weeks after the surgery, consists of pain, edema, stiffness, and vasomotor disturbances. RSD occurs in 5% of patients, affecting 3% of men and 7% of women; treatment includes sympathetic blockade for symptomatic relief.

The patient will likely judge his or her own result subjectively, with the perception of functional improvement as an endpoint. Andrew found that MCP contracture invariably was corrected (86% excellent), whereas good results for PIP contracture were less frequent (40% excellent result in middle and ring fingers; 20% in small fingers). [2] Excellent results in the correction of secondary contracture of the distal interphalangeal (DIP) joint occurred in approximately 50% of cases.

Indications for surgery depend on the patient’s requirements for hand function, the patient’s age, the severity of the contracture, and the joint or joints involved. Generally, surgery is not necessary until contracture occurs. [3]

MCP flexion contracture of 30º or more is an accepted criterion for surgical correction. [3, 4] At this point, flexion becomes functionally significant for most people; even in the ulnar digits where there is some carpometacarpal (CMC) extension range. MCP-joint flexion contracture of up to 60º has been easily correctable. [5]

PIP flexion contracture of any degree constitutes an indication for surgery. A flexion contracture of the PIP joint quickly becomes more difficult to correct because of shortening of collateral ligaments and fibrosis and adherence of periarticular structures such as the volar plate.

Adequate correction may require joint release after the resection of contracted, diseased tissue. Shortening of neurovascular bundles can also limit extension after release in long-standing PIP contracture. Because of these technical challenges, complete correction is less common, and persistence of joint flexion contracture is more likely. [5, 2]

Neurovascular compromise due to Dupuytren disease is an indication for intervention. Secondary involvement of periarticular structures may also require correction.

Thumb flexion deformities are well tolerated and less functionally significant; therefore, they are less urgently corrected. However, significant first web space contracture involving the thumb warrants surgical intervention. [5]

Some believe that early surgical intervention is more likely than delayed surgery to yield excellent results, whereas others believe that with natural disease progression, radical prophylactic palmar clearance potentiates the need for revisions. [6, 7] Surgical techniques for Dupuytren disease include closed (or percutaneous) and open fasciotomy, regional (or limited) palmar fasciectomy, and radical (or total) fasciectomy. [8] (See the images below.)

Two important considerations are adequate release of longitudinal tension and the management of involved skin. Other important decisions involve selection of the incisions required and any special method of wound closure employed. The patient’s age and functional requirements and the potential for recurrent disease also impact decisions on the extent of surgery.

Total fasciectomy prevents recurrence because the entire diseased fascia is removed, along with the central, lateral, spiral, natatory, and retrovascular cords, as well as any normal fascia that may later be affected.

As stated above, a limited fasciectomy of the pretendinous cord is usually sufficient to establish normal function in the MCP joint. McFarlane favored a regional fasciectomy of the pretendinous cord to prevent recurrence of Dupuytren contracture. [1] For longitudinal incisions, Z-plasties or multiple Y-to-V advancements may adequately close the wound. A transverse incision may be necessary for more extensive disease; in such cases, a full-thickness skin graft may be required for the defect, or the wound may have to heal secondarily. [9]

Given the difficulty of correcting severe disease, fasciectomy is indicated for any amount of PIP joint contracture. Unfortunately, recurrence is common. The procedures of choice in the PIP joint are dermatofasciectomy and total fasciectomy.

In a study by Donaldson et al, the extent of a patient’s preoperative deformity was found to be a significant predictor of complete intraoperative correction in Dupuytren contracture. [10] In addition, the extent of preoperative deformity and intraoperative correction were significant predictors of loss of surgical correction after surgery. The investigators prospectively studied 52 patients who underwent primary fasciectomy for Dupuytren disease, to determine whether preoperative contracture and the amount of intraoperative correction can predict postoperative outcome.

In this study, 42 MCP joints were treated, of which 41 achieved full intraoperative correction; 37 had full correction at 6 months’ follow-up. [10] Of the 58 PIP joints treated surgically, full intraoperative correction was obtained in 35, and 13 had complete correction at 6 months’ follow-up.

In another study, Villani et al found that full-thickness skin grafts prevented recurrence of Dupuytren contracture in 20 out of 23 hands after more than 8 years’ follow-up. [11] Of the 18 patients who underwent dermofasciectomy and skin grafting, 13 received skin grafts on one hand, and five patients received grafts on both hands. The authors noted that because recurrence is difficult to predict, primary skin grafting remains controversial and that indications for the skin-grafting procedure are more definite once recurrence has taken place. [12]

The surgeon, the patient, or both may choose either regional (local, median, or ulnar nerve block) or general anesthesia for the procedure. Regional anesthesia performed more proximally decreases tourniquet-related discomfort. Hurst uses bupivacaine HCl without epinephrine for its longer duration of nerve blockage. (Note that regional anesthesia should not be used if the patient has any of the following conditions: coagulopathy, psychosis, peculiar or unstable personality, or progressive neurologic disease.)

Various incisions can facilitate exposure during surgery for Dupuytren disease. [13]  Incisions can be transverse, longitudinal, or combined, depending on the pattern of involvement.

For a single digit, a midline volar incision closed with multiple Z-plasties can be employed. Some authors believe that a midline digital incision is least likely to expose a neurovascular bundle to injury. Alternatively, a volar zigzag incision or V-Y plasty can be used. [14]  Overall, digital Z-plasty incisions have been shown to give excellent exposure and functionally stable scars. [6]

For palmar disease with multiple MCP flexion contractures, a transverse incision at the level of distal palmar crease can be made. This can be joined to longitudinal digital incisions if necessary. Part of the palmar incision(s) can be left open, as in McCash’s open technique. Alternatives for palmar disease include palmar V-Y plasty.

Safe dissection during surgery for Dupuytren disease is enhanced by the use of loupe magnification. Sharp dissection is usually employed in separation of skin from the underlying diseased fascia. Dissection of the skin from the underlying fascia may leave very thin skin flaps, particularly in the digits.

If skin grafts are employed in the digits, they should extend from midlateral line to midlateral line across the digit.

In a severely involved digit, the neurovascular bundle may be most easily located distally. Dissecting retrovascular disease is important. Awareness of possible displacement of the neurovascular structures is essential.

Proximal division of the pretendinous cord may facilitate dissection by allowing finger extension and abduction.

In planning reoperative surgery for Dupuytren disease, if clinical evaluation suggests that the digital nerve has been severed, one should assume that the related digital artery has also been severed and should confirm adequate contralateral circulation to that digit.

Skin grafting

Excision of skin (and fascia) leaves a wound that requires additional coverage. Although McIndoe and Beare believed that grafts were practically unnecessary, [6, 15]  they reported a lower recurrence rate of Dupuytren disease when grafts or flaps were placed in flexion creases. It has generally been believed that skin replacement should be reserved for young patients who have an active diathesis, postfasciectomy recurrence, or a rapid progression of skin fixation and deformity. [16]  Skin grafting has also been used in conjunction with the open-palm technique of McCash.

Good results with a technique of limited palmar fasciectomy with skin grafting have been reported. [17]

Reports have not confirmed either a lower rate of recurrence or better functional results when skin grafting is combined with other procedures. [18]

Generally, authors recommending digital dermofasciectomy prefer full-thickness skin grafting to split-thickness skin grafting, because of increased wound contraction beneath the latter. Ipsilateral inner-arm donor sites can be used for skin grafting, while distant donor sites, including the distal lower extremity, have been suggested for improved cosmesis. [19]

The successful use of skin grafts requires a protective dressing and precludes early or vigorous interphalangeal joint movement. [20]


Local flap wound closure (beyond Z-plasty) has rarely been used. An L-shaped skin flap, called the Jacobsen flap, was developed as a modification of the McCash technique by Tripoli and Merle. [21]  Upon flap transposition, a more limited 15mm palmar skin defect is left to heal by secondary intention. The authors reported satisfactory correction of contracture and a low complication rate in 98 cases using this technique.

Free microvascular transfer of a circumflex scapular artery perforator flap was reported for coverage of a very large palmar defect after radical dermofasciectomy for disabling recurrent Dupuytren disease. [22]  Following multiple revisions and extensive hand rehabilitation, flexion deformities were significantly improved and satisfactory function was obtained.

In closed fasciotomy for Dupuytren disease, a limiting cord of diseased, superficial fascia is incised via an overlying skin incision. This technique can be successful in MCP contractures but is not as useful for PIP contracture, in that more than one cord is usually present. Closed fasciotomy presents some risk of neurovascular injury.

One indication described is to facilitate hygiene in a debilitated elderly patient who has contractures that keep the fingernails in contact with the palmar skin or produce secondary wounds. Closed fasciotomy has also been used as an initial stage in very severe contracture to facilitate further release.

In a nonselected series of 160 patients treated with closed fasciotomy, with a 10-year follow-up for the 51% of patients remaining alive, Duthie and Chesney concluded that closed fasciotomy is a useful procedure for patients who may be “unsuitable for local fasciectomy.” [23] Although contracture progressed in most patients, 34% required no further surgery, while the mean time to fasciectomy for the remaining 66% was 5 years. A 4% complication rate was described for this outpatient surgery, performed under local anesthesia or nerve block. [24]

Open fasciotomy allows direct visualization of neurovascular structures. The offending cord is divided at a point not immediately underlying the skin incision. Fasciotomies are usually most successful for MCP flexion contracture. This procedure can be performed under local anesthesia and recovery is rapid; however, the recurrence rate is high. Open fasciotomy is usually reserved for patients who cannot tolerate a more extensive procedure.

Segmental aponeurectomy of Moermans [25, 26] is a procedure that is intermediate between simple fasciotomy and limited fasciectomy. Segments (1 cm in length) of fascia are excised through C-shaped incisions. Moermans claimed that a Dupuytren cord can resolve once the tension across it is diminished. A prospective study performed by Andrew demonstrated a recurrence rate comparable to that of other techniques, but with fewer complications. [27] This is an outpatient procedure.

Percutaneous needle fasciotomy (PNF), adopted by a group of French rheumatologists and repopularized by Foucher and other European surgeons, is a minimally invasive treatment that is usually performed as an office procedure under local anesthesia. [28, 29] It involves multiple puncture sites and sectioning of the Dupuytren cord using the bevel of a needle.

In study of 211 older patients, (average age, 65 years), one digital nerve injury, no infections, and no tendon injuries were found with needle “aponeurotomy.” [30] However, recurrence (58%) and disease activity (69%) were high at the 3-year follow-up.

Foucher et al believed this technique to be ideal for the elderly patient with a bowing cord and a predominant MCP joint contracture. [30] Limitations of fasciotomy in treating digital disease and PIP contracture were again noted.

Contraindications for PNF include infiltrating disease, rapid recurrence in a young patient, inaccessible multiple cords, chronic digital disease, and postsurgical recurrence in the digits. [30]

Van Rijssen et al [31] compared PNF with limited fasciectomy, with short-term follow up, and found less discomfort, quick recovery, and better immediate hand function in the PNF group. PNF demonstrated an improvement of 63% in passive extension deficit and no significant complications. Whereas fasciectomy produced more improvement in contracture, particularly in more advanced cases, the major complication rate was 5%. The authors also noted the need to avoid applying PNF in a zone at the junction of the palm and the base of the finger where the neurovascular bundle may be displaced superficially and toward the midline and be more vulnerable to injury.

Van Rijssen et al concluded from another study that PNF was a good treatment alternative to limited fasciectomy in patients with a total passive extension deficit of 90º or less.

This is the most commonly performed procedure for Dupuytren disease. In regional, or limited, fasciectomy, only the diseased parts of the superficial fascial aponeurosis are excised. These include, for example, pretendinous cords and involved natatory ligaments in the palm, as well as the visibly affected structures in the fingers. Although Dupuytren disease may recur or progress by extension in the nonoperated areas of the hand, good results have been obtained, with acceptable complication rates. [7, 32]

In another study, Hueston concluded that regional fasciectomy does not prevent recurrence but does allow correction of deformity, with more rapid recovery of hand function. Complications were described in 96 operated hands, with hematoma in 7.5%, problematic or persistent edema in 15.5%, digital nerve injury in 2%, skin necrosis in 2%, and wound infection in 1%. [7] “Functional recovery” was delayed beyond 6 weeks in 15.5%. The rate of hematomas was found to be less than half of that reported in radical fasciectomy. At 2-year follow-up, 27 patients were found to have “extension,” and 12 were found to have true recurrence of diseased tissue.

Percutaneous aponeurotomy has been described as an potential minimally invasive alternative to limited fasciectomy in this setting. [33]

Radical, or total, surgery was thought by McIndoe and Beare to “cure” Dupuytren disease. [6] They sought to eliminate recurrent Dupuytren disease through complete removal of the palmar aponeurosis and natatory ligaments, working from the idea that Dupuytren nodules cannot form if no remnant of palmar fascia is present. In the digits, all diseased cords and tissue that may be affected are excised.

McIndoe and Beare [6] reported satisfactory results in over 200 cases with an extended or total palmar fasciectomy utilizing a transverse palmar incision with separate Z-plasty incisions (used, when necessary, in the digits). The authors, who employed hypotensive anesthesia and drains, reported that skin grafting was practically never necessary. Specific data on complications were not provided.

Whereas McIndoe and Beare believed that small hematomas would drain spontaneously, others reported hematoma formation with subsequent swelling and stiffness (as well as infection) to be a formidable problem with this procedure. [7]

Unfortunately, recurrent disease was not eliminated by the more extensive surgery. Hueston found a nearly equal recurrence rate at 5- to 15-year follow-up in a comparison of limited fasciectomy and more radical procedures. [7] He reserved radical fasciectomy for those few patients with extensive and diffuse involvement of the entire palm in Dupuytren disease. He found this approach to be necessary in roughly 10% of his patients.

McCash reduced the incidence of hematoma by leaving his transverse palmar incision open for closure by secondary intention (open palm technique). [34] The McCash technique is most often used when diffuse involvement of the entire palm dictates extended or radical fasciectomy. A delayed skin graft can be employed for closure of the palmar wound.

Hueston encountered a 28% overall rate of recurrence following surgical treatment of Dupuytren disease. Early and aggressive (or repeated) recurrence was seen in younger patients. Hueston found that full-thickness skin grafts appeared to “arrest” this process. He theorized that the skin flaps overlying fasciectomy were the (extrinsic) source of recurrent Dupuytren tissue rather than unresected elements of palmar fascia left after fasciectomy. [35, 36]

These observations led him to employ dermofasciectomy for recurrent disease, particularly in the digits. In dermofasciectomy, diseased fascia and the overlying skin are excised completely, and full-thickness skin grafting is applied for closure. Later reports of McCann and Logan suggested the dermis as a possible source for myofibroblasts causing recurrent disease. [37]

Tonkin reported that dermofasciectomy with skin grafting prevented recurrent Dupuytren disease without compromising hand function, suggesting it as a prophylactic approach in young patients with Dupuytren diathesis. [38]

Logan recommended dermofasciectomy as the first line of treatment for recurrent digital Dupuytren disease but found that it did not prevent recurrence in all cases. [39] He also noted that the immobilization required for the associated skin grafts interfered with early postoperative rehabilitation.

McFarlane criticized this approach on the grounds that it may not address the presence of diseased retrovascular tissue and suggested that the exposed flexor tendon sheath is unfavorable as a graft bed. He felt that it was usually possible to separate the diseased fascia from the overlying skin.

Other authors confirmed recurrent Dupuytren disease following this procedure. [40, 41] Armstrong et al found a recurrence rate of 11.6% in 103 patients undergoing dermofasciectomy, but they still advanced it as the best method for control of “diffuse Dupuytren disease with involvement of the skin.” [19] They raised the possibility that dermofasciectomy was unpopular because of concerns about the success of the skin grafting required.

Successful use of bone distraction and tissue expansion techniques has led to the use of distraction devices in conjunction with fasciectomies. According to Messina, this technique of gradual passive extension allowed salvage of severely contracted digits. [42, 43, 44, 45]

The application of continuous passive extension was used to elongate the contracted palmar fascia. Authors described reorganization of the once densely packed collagen fibers in the cords of Dupuytren disease into a parallel, ribbonlike appearance. [43]

In 1994, another device for PIP extension, referred to as the Proximal Interphalangeal Skeletal Traction Extender, was introduced by Hodgkinson for preoperative outpatient use. [46] Authors believe that this device makes adjacent tissues more available and decreases PIP flexion contracture, thus facilitating successful surgery.

Correction of the PIP joint is a more difficult technical problem in Dupuytren disease. If complete extension is not obtained by careful digital fasciectomy, the options are either to rely on postoperative therapy and splinting or to perform some form of volar PIP joint release. PIP joint release is usually employed when the flexion contracture is greater than 30º. The flexor sheath can be incised and the lateral proximal attachment of the volar plate (so-called checkrein ligaments) released, as necessary.

However, if these maneuvers do not achieve full PIP extension, some have recommended further joint capsulotomy, as described by Curtis. [47] His stepwise approach involved sequential release of accessory collateral ligaments followed by release of the proper collateral ligaments on one side of the joint at a time until full joint extension was achieved or all structures had been released.

Others have cautioned that the correction achieved at surgery would not be maintained and that aggressive capsulotomy of the PIP joint is likely to result in permanent loss of flexion range, which is more limiting than a mild flexion contracture. [48]

In 1979, Watson et al examined 115 checkrein releases and found full intraoperative extension in 110 joints, with additional release necessary in only five joints. [49] They concluded that releasing the accessory collateral or proper collateral ligaments is almost never required with successful checkrein excision.

McFarlane and Botz discouraged the use of capsulotomy in patients with chronic PIP contracture if correction to 40º of flexion or less could be obtained. [48]

A study by Weinzweig et al of 42 involved PIP joints in 28 patients demonstrated no advantage to capsuloligamentous release in comparison with fasciectomy alone. [50] The authors also felt that stretching or adherence of the extensor mechanism with prolonged flexion contracture could render it ineffective, contributing to late return of flexion deformity.

Alternatives for severe PIP joint contracture include arthroplasty (including implant arthroplasty) and arthrodesis. The shortening concomitant with arthroplasty (or arthrodesis) results in improvement of the contracture. Whereas PIP arthrodesis establishes a desired functional angle at the joint, it further limits function.

Amputation is rarely necessary in digital disease. It is usually performed in elderly patients with a severely contracted fifth digit following thorough surgeon-patient discussion and realistic analysis of attainable function.

Hyperextension of the DIP joint usually occurs secondary to long-standing PIP joint contracture, with foreshortening of the Landsmeer ligament (oblique retinacular ligament); the DIP joint itself remains normal. If DIP joint deformity is passively correctable, it usually resolves with correction of PIP contracture. If it is not passively correctable, division of Landsmeer ligaments usually corrects the deformity. Severe fibrosis of dorsal skin related to knuckle pads can also limit DIP joint flexion.

Proper postoperative care is essential for a successful surgical outcome. The protocol includes splinting in extension and an exercise regimen with a therapist for the institution of range-of-motion (ROM) exercises within the first week after surgery. Patients who undergo PIP joint surgery commonly undergo 6 weeks of continual splinting, including splinting at night, and may require bracing for as long as 3 months overall to minimize secondary scar contractures. [51, 52]  A 2017 systematic review cast doubt on the utility of static night orthosis after surgical correction of Dupuytren contracture. [53]

Given that surgery for Dupuytren disease is most often performed on an outpatient basis, close follow-up in the early postoperative period is recommended. Early motion is encouraged. Some surgeons feel that routine, formal, supervised hand therapy at an early stage of healing is important for functional rehabilitation. Many use intermittent static extension splinting for more resistant contractures. As wound healing progresses, the patient can be encouraged to use the hand in activities of daily living, and more vigorous passive ROM exercises can be employed.


Tourniquet release and meticulous hemostasis prior to wound closure are recommended. Adequate drainage, such as an open area in a palmar surgical site, has been beneficial.

Skin loss

Skin flaps can fail for many reasons, but underlying hematoma is a frequent problem. The skin may be very thin after dissection from the underlying fascia. In this situation, if skin viability is in doubt, a preemptive skin graft may be a better option. Potential donor sites can be identified preoperatively.


Infection usually follows hematoma, skin loss, or both. If contracture prevents adequate skin preparation, a fasciotomy can be performed as a preliminary measure before definitive fasciectomy.

Division of digital nerve or artery

Dissection in a fasciectomy is similar to neurolysis; that is, the involved neurovascular bundles must be dissected free along the entire course of the surgical wound. The area of greatest risk is adjacent to the web space over the base of the proximal phalanx. Awareness of the displacement of the neurovascular bundle to the midline by a spiral cord is important. Surgeons should be prepared for appropriate repair of divided nerves and arteries.

Loss of flexion range

This is a common late complication. Active and passive preoperative ROM should be recorded. Active flexion exercises should be part of early postoperative care. Maintenance of flexion range is often neglected in the effort to regain full extension. Schneider reported a 41% loss of flexion range after surgery for palmar disease. [3]

Reflex sympathetic dystrophy or chronic regional pain syndrome (CRPS type 1)

Several authors have warned that RSD is a significant problem after surgery for Dupuytren disease. [54, 55, 56]  Luck reported that features of RSD were observed with increased frequency after surgery for Dupuytren disease. [57]  This complication is at least five times more common in women than in men with Dupuytren disease.

Other postoperative pain

Local hyperalgesia, possibly due to digital nerve injury and neuroma formation, can be problematic. [57]


Recurrence (ie, Dupuytren tissue forming in the area of resection) and recurrence of flexion deformity with disease extension (ie, Dupuytren tissue appearing outside the area of resection) are believed to be separate entities. [58]  Recurrence is much more likely in a young patient with a strong family history and knuckle pads. [7]  A recurrence rate ranging between 26% and 80% has been reported.

In his evaluation of 224 patients who underwent fasciectomy, Hueston concluded that recurrence is rare after 2 years postoperatively. He also concluded that recurrence is less frequent in older patients but is an early postoperative event in younger patients with Dupuytren diathesis, with some patients requiring multiple reoperations. [35, 36]  The incidence of recurrence has been decreased, but not completely eliminated, with skin replacement techniques.

Definitions of what constitutes recurrence of Dupuytren disease have varied in the literature. A group of 21 experts arrived at a consensus definition, proposing that recurrence be defined as  more than 20º of contracture recurrence in any treated joint at 1 year after treatment as comapred with 6 weeks after treatment. [59] In addition, the group recommended that recurrence should be reported individually for every treated joint and that afterward, measurements should be repeated and reported yearly.

McFarlane RM, McGrouther DM. Complications and their management. McFarlane RM, McGrouther DA, Flint MH, eds. Dupuytren’s Disease: Biology and Treatment. Edinburgh: Churchill Livingstone; 1991. 377-82.

Andrew JG. Contracture of the proximal interphalangeal joint in Dupuytren’s disease. J Hand Surg Br. 1991 Nov. 16(4):446-8. [Medline].

Schneider LH. The open palm technique. Hand Clin. 1991 Nov. 7(4):723-8; discussion 729. [Medline].

Hueston JT. Dupuytren’s contracture. Flynn JE. Hand Surgery. 3rd ed. Baltimore, Md: Williams & Wilkins; 1982.

Smith AC. Diagnosis and indications for surgical treatment. Hand Clin. 1991 Nov. 7(4):635-42; discussion 643. [Medline].

McINDOE A, BEARE RL. The surgical management of Dupuytren’s contracture. Am J Surg. 1958 Feb. 95(2):197-203. [Medline].

HUESTON JT. Limited fasciectomy for Dupuytren’s contracture. Plast Reconstr Surg Transplant Bull. 1961 Jun. 27:569-85. [Medline].

Rodrigues JN, Becker GW, Ball C, Zhang W, Giele H, Hobby J, et al. Surgery for Dupuytren’s contracture of the fingers. Cochrane Database Syst Rev. 2015 Dec 9. CD010143. [Medline].

Lee H, Eo S, Cho S, Jones NF. The Surgical Release of Dupuytren’s Contracture Using Multiple Transverse Incisions. Arch Plast Surg. 2012 Jul. 39(4):426-30. [Medline]. [Full Text].

Donaldson OW, Pearson D, Reynolds R, Bhatia RK. The association between intraoperative correction of Dupuytren’s disease and residual postoperative contracture. J Hand Surg Eur Vol. 2010 Mar. 35(3):220-3. [Medline].

Villani F, Choughri H, Pelissier P. [Importance of skin graft in preventing recurrence of Dupuytren’s contracture]. Chir Main. 2009 Dec. 28(6):349-51. [Medline].

Hueston JT. Dermofasciectomy for Dupuytren’s disease. Bull Hosp Jt Dis Orthop Inst. 1984 Fall. 44(2):224-32. [Medline].

Gelberman RH, Panagis JS, Hergenroeder PT, Zakaib GS. Wound complications in the surgical management of Dupuytren’s contracture: a comparison of operative incisions. Hand. 1982 Oct. 14(3):248-54. [Medline].

Mahaffey PJ. V-Y plasty for Dupuytren’s contracture of the palm. J R Coll Surg Edinb. 1996 Dec. 41(6):425. [Medline].

HUESTON JT. Digital Wolfe grafts in recurrent Dupuytren’s contracture. Plast Reconstr Surg Transplant Bull. 1962 Apr. 29:342-4. [Medline].

Heuston JT. The control of recurrent Dupuytren’s contracture by skin replacement. Br J Plast Surg. 1969 Apr. 22 (2):152-6. [Medline].

Gonzalez RI. The use of skin grafts in the treatment of Dupuytren’s contracture. Hand Clin. 1985 Nov. 1(4):641-7. [Medline].

Ullah AS, Dias JJ, Bhowal B. Does a ‘firebreak’ full-thickness skin graft prevent recurrence after surgery for Dupuytren’s contracture?: a prospective, randomised trial. J Bone Joint Surg Br. 2009 Mar. 91(3):374-8. [Medline].

Armstrong JR, Hurren JS, Logan AM. Dermofasciectomy in the management of Dupuytren’s disease. J Bone Joint Surg Br. 2000 Jan. 82(1):90-4. [Medline].

Logan AJ, Mason G, Dias J, Makwana N. Can rock climbing lead to Dupuytren’s disease?. Br J Sports Med. 2005 Sep. 39(9):639-44. [Medline]. [Full Text].

Tripoli M, Merle M. The “Jacobsen Flap” for the treatment of stages III-IV Dupuytren’s disease: a review of 98 cases. J Hand Surg Eur Vol. 2008 Dec. 33(6):779-82. [Medline].

Branford OA, Davis M, Schreuder F. The circumflex scapular artery perforator flap for palm reconstruction in a recurrent severe case of Dupuytren’s disease. J Plast Reconstr Aesthet Surg. 2009 Dec. 62(12):e589-91. [Medline].

Duthie RA, Chesney RB. Percutaneous fasciotomy for Dupuytren’s contracture: a 10-year review. J Hand Surg [Eur]. 1997 Aug 1. 22 (4):521-2.

Denkler K. Dupuytren’s fasciectomies in 60 consecutive digits using lidocaine with epinephrine and no tourniquet. Plast Reconstr Surg. 2005 Mar. 115(3):802-10. [Medline].

Moermans JP. Long-term results after segmental aponeurectomy for Dupuytren’s disease. J Hand Surg Br. 1996 Dec. 21(6):797-800. [Medline].

Moermans JP. Segmental aponeurectomy in Dupuytren’s disease. J Hand Surg Br. 1991 Aug. 16(3):243-54. [Medline].

Andrew JG, Kay NR. Segmental aponeurectomy for Dupuytren’s disease: a prospective study. J Hand Surg Br. 1991 Aug. 16(3):255-7. [Medline].

Morhart M. Pearls and pitfalls of needle aponeurotomy in Dupuytren’s disease. Plast Reconstr Surg. 2015 Mar. 135 (3):817-25. [Medline].

Medjoub K, Jawad A. The use of multiple needle fasciotomy in Dupuytren disease: retrospective observational study of outcome and patient satisfaction. Ann Plast Surg. 2014 Apr. 72 (4):417-22. [Medline].

Foucher G, Medina J, Navarro R. Percutaneous needle aponeurotomy: complications and results. J Hand Surg Br. 2003 Oct. 28(5):427-31. [Medline].

van Rijssen AL, Gerbrandy FS, Ter Linden H, Klip H, Werker PM. A comparison of the direct outcomes of percutaneous needle fasciotomy and limited fasciectomy for Dupuytren’s disease: a 6-week follow-up study. J Hand Surg Am. 2006 May-Jun. 31(5):717-25. [Medline].

HAMLIN E Jr. Limited excision of Dupuytren’s contracture. Ann Surg. 1952 Jan. 135(1):94-7. [Medline]. [Full Text].

Kan HJ, Selles RW, van Nieuwenhoven CA, Zhou C, Khouri RK, Hovius SE. Percutaneous Aponeurotomy and Lipofilling (PALF) versus Limited Fasciectomy in Patients with Primary Dupuytren’s Contracture: A Prospective, Randomized, Controlled Trial. Plast Reconstr Surg. 2016 Jun. 137 (6):1800-12. [Medline].


HUESTON JT. Recurrent Dupuytren’s contracture. Plast Reconstr Surg. 1963 Jan. 31:66-9. [Medline].

Hueston JT. Dupuytren’s Contracture. London: E&S Livingstone; 1963.

McCann BG, Logan A, Belcher H, Warn A, Warn RM. The presence of myofibroblasts in the dermis of patients with Dupuytren’s contracture. A possible source for recurrence. J Hand Surg Br. 1993 Oct. 18(5):656-61. [Medline].

Tonkin MA, Burke FD, Varian JP. Dupuytren’s contracture: a comparative study of fasciectomy and dermofasciectomy in one hundred patients. J Hand Surg Br. 1984 Jun. 9(2):156-62. [Medline].

Logan AM, Brown HG, Lewis-Smith P. Radical digital dermofasciectomy in Dupuytren’s disease. J Hand Surg Br. 1985 Oct. 10(3):353-7. [Medline].

Ketchum LD, Donahue TK. The injection of nodules of Dupuytren’s disease with triamcinolone acetonide. J Hand Surg Am. 2000 Nov. 25(6):1157-62. [Medline].

Brotherston TM, Balakrishnan C, Milner RH, Brown HG. Long term follow-up of dermofasciectomy for Dupuytren’s contracture. Br J Plast Surg. 1994 Sep. 47(6):440-3. [Medline].

Bailey AJ, Tarlton JF, Van der Stappen J, Sims TJ, Messina A. The continuous elongation technique for severe Dupuytren’s disease. A biochemical mechanism. J Hand Surg Br. 1994 Aug. 19(4):522-7. [Medline].

Brandes G, Messina A, Reale E. The palmar fascia after treatment by the continuous extension technique for Dupuytren’s contracture. J Hand Surg Br. 1994 Aug. 19(4):528-33. [Medline].

Bailey AJ, Tarlton JF, Van der Stappen J, Sims TJ, Messina A. The continuous elongation technique for severe Dupuytren’s disease. A biochemical mechanism. J Hand Surg Br. 1994 Aug. 19(4):522-7. [Medline].

Messina A, Messina J. The continuous elongation treatment by the TEC device for severe Dupuytren’s contracture of the fingers. Plast Reconstr Surg. 1993 Jul. 92(1):84-90. [Medline].

Hodgkinson PD. The use of skeletal traction to correct the flexed PIP joint in Dupuytren’s disease. A pilot study to assess the use of the Pipster. J Hand Surg Br. 1994 Aug. 19(4):534-7. [Medline].

CURTIS RM. Capsulectomy of the interphalangeal joints of the fingers. J Bone Joint Surg Am. 1954 Dec. 36-A(6):1219-32. [Medline].

McFarlane RM, Botz JS. The results of treatment. McFarlane RM, McGrouther DA, Flint MH, eds. Dupuytren’s Disease: Biology and Treatment. Edinburgh: Churchill-Livingstone; 1991. 393.

Watson HK, Light TR, Johnson TR. Checkrein resection for flexion contracture of the middle joint. J Hand Surg Am. 1979 Jan. 4(1):67-71. [Medline].

Weinzweig N, Culver JE, Fleegler EJ. Severe contractures of the proximal interphalangeal joint in Dupuytren’s disease: combined fasciectomy with capsuloligamentous release versus fasciectomy alone. Plast Reconstr Surg. 1996 Mar. 97(3):560-6; discussion 567. [Medline].

Balaguer T, David S, Ihrai T, Cardot N, Daideri G, Lebreton E. Histological staging and Dupuytren’s disease recurrence or extension after surgical treatment: a retrospective study of 124 patients. J Hand Surg Eur Vol. 2009 Aug. 34(4):493-6. [Medline].

Collis J, Collocott S, Hing W, Kelly E. The effect of night extension orthoses following surgical release of Dupuytren contracture: a single-center, randomized, controlled trial. J Hand Surg Am. 2013 Jul. 38(7):1285-94.e2. [Medline].

Samargandi OA, Alyouha S, Larouche P, Corkum JP, Kemler MA, Tang DT. Night Orthosis After Surgical Correction of Dupuytren Contractures: A Systematic Review. J Hand Surg Am. 2017 Oct. 42 (10):839.e1-839.e10. [Medline].

Prosser R, Conolly WB. Complications following surgical treatment for Dupuytren’s contracture. J Hand Ther. 1996 Oct-Dec. 9(4):344-8. [Medline].

Nissenbaum M, Kleinert HE. Treatment considerations in carpal tunnel syndrome with coexistent Dupuytren’s disease. J Hand Surg Am. 1980 Nov. 5(6):544-7. [Medline].

Watson HK, Fong D. Dystrophy, recurrence, and salvage procedures in Dupuytren’s contracture. Hand Clin. 1991 Nov. 7(4):745-55; discussion 757-8. [Medline].

LUCK JV. Dupuytren’s contracture; a new concept of the pathogenesis correlated with surgical management. J Bone Joint Surg Am. 1959 Jun. 41-A(4):635-64. [Medline].

Dias JJ, Singh HP, Ullah A, Bhowal B, Thompson JR. Patterns of recontracture after surgical correction of Dupuytren disease. J Hand Surg Am. 2013 Oct. 38(10):1987-93. [Medline].

Kan HJ, Verrijp FW, Hovius SER, van Nieuwenhoven CA, Dupuytren Delphi Group., Selles RW. Recurrence of Dupuytren’s contracture: A consensus-based definition. PLoS One. 2017. 12 (5):e0164849. [Medline].

Steve Lee, MD Physician in Plastic, Reconstructive, and Hand Surgery, Plastic Surgery, PLLC

Steve Lee, MD is a member of the following medical societies: American College of Surgeons, American Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Michael Baytion, MD Ohio State University College of Medicine

Disclosure: Nothing to disclose.

Yelena Bogdan Stony Brook University Health Sciences Center School of Medicine (SUNY)

Yelena Bogdan is a member of the following medical societies: Phi Beta Kappa

Disclosure: Nothing to disclose.

Derek L Reinke, MD Consulting Staff, Cary Orthopedic and Sports Medicine Specialists

Disclosure: Nothing to disclose.

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine; Clinical Professor of Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society, Florida Medical Association, Florida Orthopaedic Society

Disclosure: Nothing to disclose.

Michael S Clarke, MD Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Arthroscopy Association of North America, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Mark F Hendrickson, MD Chief, Section of Hand Surgery, Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Surgery for Dupuytren Contracture 

Research & References of Surgery for Dupuytren Contracture |A&C Accounting And Tax Services

15 thoughts on “Surgery for Dupuytren Contracture 

  1. Pingback: online casino
  2. Pingback: viagra
  3. Pingback: online viagra
  4. Pingback: cheap viagra
  5. Pingback: cialis generic
  6. Pingback: cialis 20mg
  7. Pingback: buy tadalafil

Leave a Reply