Surgical treatment

Surgical treatment has almost come full circle with Baron Dupuytren and Sir Astley Cline simultaneously describing releasing contractures with the use of a small pointed blade in the early 1800s, moving through bigger operations and now back to Needle aponeurotomy. However the standard surgical operations are still very useful and when carried out properly can give longlasting relief from contracture.

However they inevitably carry a larger load in terms of morbidity and time to return to work as a result of being more invasive.

The upside is that in general they carry a smaller risk of recurrence with dermofasciectomy having an extremely low recurrence rate in good centres.

I still routinely carry out dermofasciectomy but rarely these days, personally, do fasciectomy. I use dermofasciectomy for the patient who has had previous treatment of any sort with rapid recurrence who wants/need a stable post surgical plan with low risk of future recurrence. My idea of a dermofasciectomy is to do a complete excision of the dupuytrens and a compartment excision of the skin with a big full thickness graft. I again personally do not do small firebreak skin grafts as there are no trials to my knowledge showing an advantage.

Other surgical treatments

PIP joint arthrodesis

This is a technique which is very useful in certain cases of severe dupuytrens with major scarring of the palm of the finger. The procedure shortens the finger until the finger can be almost straightened and then the joint is held in the desired position with a plate until the bone heals. Very effective at improving the function of the little finger without the problems associated with amputation.

Amputation

Amputation can be useful for the severely scarred dysaesthetic finger. However there are significant risks associated with the surgery especially to the adjacent finger and therefore it is very much an operation of last resort.