Dupuytren's Contracture - Later Stage Treatments

Later Stage Treatments

In 1831 Baron Guillaume Dupuytren was the first to describe Dupuytren’s disease and a surgical procedure in the Lancet. The procedure he described was a minimal invasive needle procedure. Because of the high recurrence rates of the disease, new surgical techniques were introduced, such as the fasiectomy and later on also the dermofasciectomy. Although most of the diseased tissue is removed with these procedures, the recurrence rates remain high. The fasciectomy is seen as the gold standard treatment for Dupuytren’s disease. For some individuals, the partial insertion of "K wires" into either the Dip or Pip joints of the effected digit for a period of a least 21 days in order to fuse the joint is the only way to halt the progress of the disease. After removal of the wires, the joint will be fixed into flexion, the idea being that it is better to have a joint fused at flexion than fused at extension.

The patient burden after open surgery is high, therefore less invasive techniques may be preferred. New studies have been conducted for percutaneous release, extensive percutaneous aponeurotomy with lipografting, and collagenase. These treatments show promise. Several alternate therapies, including radiation and vitamin E treatment, have been tried in the past, although those studies generally lacked control groups and most contemporary doctors do not place much value on those treatments. None of these treatments have proved to be a way to stop or cure the condition permanently. In extreme cases, amputation of fingers may be needed for severe or recurrent disease, or after complications in surgery.