Minimally invasive treatments for dupuytren contracture

Abstract

Dupuytren disease is a benign inherited fibromatosis of the fascia of the hand and fingers. It leads to progressive contracture, which alters hand function. There is no known “cure” for Dupuytren contracture. Dupuytren contracture is traditionally treated with open surgical procedures, most commonly partial palmar fasciectomy. There are numerous problems associated with open fasciectomy. Regional or general anesthesia is often required. Recurrence rates vary from 12 % to 73 % and there is a significant complication rate reported between 3.9 % and 39 %. It is common for patients to require an extended period out of work and away from sports and an extensive course of postoperative hand therapy is often necessary. Even after meticulous removal of diseased fascia, the disease and contracture can recur. Needle aponeurotomy (NA/PNF) and Clostridium Histolyticum Collagenase (CCH, Xiaflex, Xiapex) injection are new minimally invasive methods used to treat Dupuytren contracture. Compared to fasciectomy, they have a lower complication rate and recovery is more rapid. Patients can return to work and sports more quickly. These procedures can be performed under local anesthesia in an office or clinic setting. The overall cost is lower; however, recurrence rates are higher than with open surgery. This chapter examines the history of minimally invasive treatment and the anatomy and physical examination of the pathological cords. Reported outcomes, efficacy, and recurrence rates are reviewed. Precise step-by-step techniques for performing NA and CCH are presented. Emphasis is placed on accuracy, maximizing correction, and minimizing potential complications. Tips and pearls from the author’s greater than 10-year experience are discussed.