Dupuytren’s disease: overview of a common connective tissue disease with a focus on emerging treatment options

Abstract

Dupuytren’s disease (DD) is a common, fibroproliferative disease of the palmar fascia of unknown pathology. DD blights the hand function of many individuals and yet it remains an unsolved conundrum. Despite clear knowledge of the anatomy of this aggressive disease and an ever-increasing understanding of the underlying pathophysiology, cellular mechanisms and genetic basis for the disease, curative treatment remains elusive. Described in the 18th century, some of the early surgical treatments remain central to management today, with the gold standard treatment continuing to be surgical removal of the diseased tissues. A plethora of nonsurgical and minimally invasive treatments have been tried with variable success; the efficacy and safety profiles of radiotherapy, steroid injection and injectable collagenase Clostridium histolyticum are explored in this article. There is also a broad range of surgical options, including percutaneous needle fasciotomy, limited or extensive fasciectomy, dermofasciectomy, salvage procedures and a variety of techniques to close the skin wound. Additionally, the role of skin grafting and the application of fat injection in DD will be discussed, with explanation of the comparative utility of each. Although a cure remains elusive, modern nonoperative management options are gaining increasing popularity. This review gives a detailed, comparative overview of each of the nonoperative and surgical treatments available to today’s clinician and suggests a treatment algorithm to aid in management and decision-making in DD.