The treatment of Dupuytren's contracture

Surgical treatment

Selective (or limited) palmar fasciectomy is usually the choice technique for surgical treatment of Dupuytren’s contracture13. Disease tissue is removed under regional anaesthesia with the objective of extending the digit and of preventing further retraction. Extra or intra articular arthrolysis is associated when the flexion of the PIP joint remains after removal of the cord; intra articular arthrolysis exposing to a higher risk of postoperative stiffness. Skin grafts are used in case of adhesive forms or high risk of recurrence. Open palm techniques (McCash) can also be used to attain complete skin cicatrisation in case of skin shortage. Buttonhole deformations of the finger are treated by tenotomy and elongation of the extensors. In most advanced situations, irreducible hooked fingers or multi operated patients, arthrodesis or amputation is performed. Drawbacks of the surgical techniques are their high rate of complications including nerve and artery transection, complex regional pain syndrome and a long recovery period of 3 to 6 weeks.