Treatment of Dupuytren's contracture; an overview of options

In this article we systematically review treatment options for Dupuytren's contracture. There is little evidence on the effectiveness of many treatment modalities for Dupuytren's disease other than expert's opinions (level 4). Most hand surgeons perform selective fasciectomy for Dupuytren's disease. Because of its lower recurrence rate, dermofasciectomy is increasingly being performed to treat recurrences. Percutaneous needle fasciotomy is a minimally invasive treatment with good short-term results in patients with mild to moderate contractures, but it has a high recurrence rate. Radiotherapy and the use of collagenase are promising, but their role in treating Dupuytren's disease is still unclear.</p

Behandeling van de ziekte van Dupuytren: Een overzicht van de mogelijkheden

In this article we systematically review treatment options for Dupuytren's contracture. There is little evidence on the effectiveness of many treatment modalities for Dupuytren's disease other than expert's opinions (level 4). Most hand surgeons perform selective fasciectomy for Dupuytren's disease. Because of its lower recurrence rate, dermofasciectomy is increasingly being performed to treat recurrences. Percutaneous needle fasciotomy is a minimally invasive treatment with good short-term results in patients with mild to moderate contractures, but it has a high recurrence rate. Radiotherapy and the use of collagenase are promising, but their role in treating Dupuytren's disease is still unclear

Five-year results of a randomized clinical trial on treatment in Dupuytren's disease:percutaneous needle fasciotomy versus limited fasciectomy

BACKGROUND: The increasing number of methods for treating Dupuytren's disease indicates a need for comparative studies. In this article, the 5-year follow-up results of a randomized controlled study that compared percutaneous needle fasciotomy and limited fasciectomy are presented. METHODS: One hundred eleven patients with 115 affected hands with a minimal passive extension deficit of 30 degrees were assigned randomly to the two groups. Follow-up examinations were performed at 1 and 6 weeks; 6 months; and 1, 2, 3, 4, and 5 years. Outcome parameters were total passive extension deficit, patient satisfaction, flexion, and sensibility. Furthermore, disease extension was recorded. The primary endpoint was recurrence, defined as an increase of total passive extension deficit of greater than 30 degrees. Ninety-three patients reached this endpoint. RESULTS: The recurrence rate after 5 years in the needle fasciotomy group (84.9 percent) was significantly higher than in the limited fasciectomy group (20.9 percent) (p < 0.001), and occurred significantly sooner in the needle fasciotomy group (p = 0.001). Older age at the time of treatment decreased the recurrence rate (p = 0.005). No other diathesis characteristics influenced recurrence. Patient satisfaction was high in both groups but was significantly higher in the limited fasciectomy group. Nevertheless, many patients (53 percent) preferred percutaneous needle fasciotomy in case of recurrence. CONCLUSIONS: Percutaneous needle fasciotomy is the preferred treatment for elderly patients with Dupuytren's disease and for those willing to accept a possible early recurrence in the context of the advantages, such as fast recovery, a low complication rate, and minimal invasiveness. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II

Correction of contracture and recurrence rates of Dupuytren contracture following invasive treatment:the importance of clear definitions

PURPOSE: To call attention to the wide variety of definitions for recurrence that have been employed in studies of different invasive procedures for the treatment of Dupuytren contracture and how this important limitation has contributed to the wide range of reported results. METHODS: This study reviewed definitions and rates of contracture correction and recurrence in patients undergoing invasive treatment of Dupuytren contracture. A literature search was carried out in January 2011 using the terms "Dupuytren" AND ("fasciectomy" OR "fasciotomy" OR "dermofasciectomy" OR "aponeurotomy" OR "aponeurectomy") and limited to studies in English. RESULTS: The search returned 218 studies, of which 21 had definitions, quantitative results for contracture correction and recurrence, and a sample size of at least 20 patients. Definitions for correction of contracture and recurrence varied greatly among articles and were almost always qualitative. Percentages of patients who achieved correction of contracture (ie, responder rate) when evaluated at various times after completion of surgery ranged from 15% to 96% for fasciectomy/aponeurectomy. Responder rates were not reported for fasciotomy/aponeurotomy. Recurrence rates ranged from 12% to 73% for patients treated with fasciectomy/aponeurectomy and from 33% to 100% for fasciotomy/aponeurotomy. Review of these reports underscored the difficulty involved in comparing correction of contracture and recurrence rates for different surgical interventions because of differences in definition and duration of follow-up. CONCLUSIONS: Clearly defined objective definitions for correction of contracture and for recurrence are needed for more meaningful comparisons of results achieved with different surgical interventions. CLINICAL RELEVANCE: Recurrence after surgical intervention for Dupuytren contracture is common. This study, which evaluated reported rates of recurrence following surgical treatment of Dupuytren contracture, provides clinicians with practical information regarding expected long-term outcomes of surgical treatment choices. TYPE OF STUDY/LEVEL OF EVIDENCE: Economic and decision analysis III