Minimally Invasive Options in Dupuytren’s Contracture

Abstract

Surgery for Dupuytren's contracture used to be the only alternative of treatment. The past 5 years have seen the widespread adoption of minimally invasive treatments in the form of needle aponeurotomy and collagenase injection to disrupt the cords and restore range of motion. Even newer and perhaps as effective treatments such as fat grafting and mechanical stretching with the Digit Widget may also end up being important tools of treatment. The reader will be introduced to all of these modalities with text, illustration, and videos.

Let’s Focus on the Fibrosis in Dupuytren Disease: Cell Communication Network Factor 2 as a Novel Target

“…For a targeted, streamlined approach, one could first choose those who have undergone treatment for symptomatic contracture. Local injection would occur at the time of definitive treatment (eg, fasciectomy, needle aponeurotomy, and manipulation), which is similar to other proposed adjuvants, such as fat grafting, 59 as well as at distinct time points after treatment to prevent recurrence, such as at 6 weeks and 3 months, which is consistent with published data on corticosteroid injection. 60 Third, we anticipate that the potential side effect profile would be acceptable.…”

Minimally Invasive Hand Surgery and Treatment

“…This includes percutaneous needle fasciotomy and collagenase injection. The percutaneous needle fasciotomy involves using a 25-gauge needle to perforate the cord along several points to weaken it and ultimately straightening the finger [9].…”

“…With the introduction of collagenase onto the market in 2010 we have seen a down turn in surgical intervention for single cord and less severe contractures. While both of these less invasive procedures have gained popularity with surgeons and patients, they do carry a higher recurrence rate compared to open surgery [9,10].…”

Treatment Options for Dupuytren’s Disease: Tips and Tricks

“…Morhart and Stromberg (open access) have presented fine articles on PNF technique, and Eaton has an excellent video (See Video 2 [online], which displays the percutaneous needle aponeurotomy of a left ring finger Dupuytren cord with metacarpophalangeal and proximal interphalangeal joint contractures 45 and 65 degrees, respectively). 44–46 Advanced PNF techniques are necessary for severe DD. (See Video 3 [online], which displays the advanced PNF technique treating a severe MCPJ and PIPJ contracture.…”