Jeremy Field - Consultant Orthopaedic and Hand Surgeon

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1. Percutaneous Fasciotomy - In certain contractures which involve the MCPJ only and a band covering down the palm it is feasible to release the contracture under local anaesthetic using the cutting edge of a needle as a blade. - This is performed only for specific types of contracture, particularly contracture of the 1st knuckle (MCP joint) i.e. the finger is bent at the first knuckle and the rest of the finger is straight.

It is successful in that the finger can be made straighter however it really is a temporary measure and may give the patient 3-5 years before definitive surgery will need to be performed.

2. Collagenase Injection (Xiapex) - this is a new treatment for Dupuytren’s Disease that involves injecting collagenase under local anaesthetic into the Dupuytrens lump in order to dissolve part of the disease. The patient has to attend the following day for a manipulation to straighten the bent finger. In certain contractures which involve the MCPJ only and a band covering down the palm it is feasible to use this injection. This is performed only for specific types of contracture, particularly contracture of the first knuckle (MCP joint) i.e. the finger is bent at the first knuckle and the rest of the finger is straight.

We do not know the long term outcome of this procedure, but it may be a temporising measure like the percutaneous fasciotomy (see above). It may give the patient 3-5 years before definitive surgery will need to be performed. For further information collagenase injection.

3. Surgical Release - this involves the removing of the tight band of tissue and it called a fasciectomy. The wound is closed in zigzag fashion. Sometimes a skin graft is taken from the forearm (dermofasciectomy).

The operation is not a small one. It involves a lot of hard work on the patient's part after the operation by means of splinting and physiotherapy to gain the best results. Unfortunately Dupuytren's disease has a tendency to recur and five year recurrence rate is recorded as 25% in the hand and higher (40%) in the little finger.

Sometimes the skin is involved in this procedure, particularly in revision Dupuytren's (when the surgery has to be done again). In this case it is common that a dermofascietomy is performed. This involves excising all the skin that is involved within the Dupuytren's tissue and replacing it with a skin graft. It is generally taken from the forearm or the flexion crease of the elbow. The skin graft is fashioned to fill the defect and the defect and the skin sewed in over a sponge dressing, which has to be maintained for two weeks.