Dupuytren Roundtable Discussions

Here are links to two recently published roundtable discussions by experts in the field of Dupuytren's. Although these were discussions by surgeons for surgeons, they are really just conversations and quite readable. They highlight the current challenges both surgeons and their patients face with Dupuytren's disease and provide insight into future efforts to develop a biological cure.

American Association of Hand Surgeons (go to page 6): http://www.dupuytrenfoundation.org/DupPDFs/2010_AAHS.pdf

American Academy of Orthopaedic Surgeons: http://www.dupuytrenfoundation.org/DupPDFs/2011_AAOS.pdf

Coming up: What is known about Dupuytren's and Chondroitin/Glucosamine?

Personal experiences with Xiaflex and Needle Aponeurotomy

Xiaflex is now available, and is generating reports by both traditional writers and self published social media authors. There are now two minimally invasive treatments for contractures due to Dupuytren's disease - Xiaflex injection and needle aponeurotomy - with relative advantages and disadvantages of each. The following video was made by a Dupuytren's patient, documenting experience with needle aponeurotomy: http://www.youtube.com/watch?v=lGD9RjmFBzo. Another person's documentary experience with Xiaflex, also with videos, is posted here: http://bit.ly/9RhqQA. Their experiences were different, but both are satisfied with their results. Every hand is different and no one treatment works for everyone, but it's great that there are new options to choose from to buy time while researchers work for a cure. The Dupuytren Foundation is actively recruiting volunteers and fund raising options to develop better treatments - and eventually a cure. Support the effort. Make a difference. http://www.DupuytrenFoundation.org

Fasciectomy: Unsafe at any Speed?

Fasciectomy, invented by Goyrand just a few years after Dupuytren's initial demonstration of open fasciotomy, has been the main treatment option for Dupuytren's for nearly 200 years. There have been many refinements, but the central theme of removing fascia is unchanged. With so much time and experience, one might assume that all of the wrinkles had been ironed out. Not so. Fasciectomy has inherent, unavoidable dangers even in experienced hands because of both technical difficulty and biologic reaction. In this recent report, "Surgical Complications Associated With Fasciectomy for Dupuytren's Disease: A 20-Year Review of the English Literature" (full text: http://www.dupuytrenfoundation.org/DupPDFs/2010_Denkler.pdf), the numbers are notable. On the average, one out of six fasciectomy patients experience a major complication; more if the procedure is for recurrent disease; even more if one asks the patients rather than the surgeons. This risk is hard to justify for the treatment of a benign condition. We need better treatment options to straighten out bent fingers, but also to prevent contractures from progressing or recurring.

FDA approves Collagenase for Dupuytren's

Collagenase (Xiaflex) has been approved by the FDA for treatment of Dupuytren's contracture, after years of intensive laboratory and clinical trials. Collagenase enzymatic  fasciotomy is more similar to needle fasciotomy than to either open fasciotomy or fasciectomy in terms of rapid recovery and low complication rate. Compared to needle release, collagenase enzymatic fasciotomy should eventually be more widely available (because it is easier for surgeons to learn), takes less time to perform, but provokes more inflammation and will be more expensive. Auxilium's press release (full text: http://www.dupuytrenfoundation.org/DupPDFs/2010_Auxilium1.pdf) and physician prescribing information (full text: http://www.dupuytrenfoundation.org/DupPDFs/2010_Auxilium2.pdf) are now available. We live in exciting times for Dupuytren's because for nearly 200 years, there has been essentially one treatment option, surgery, but within the last few years, this has expanded to also include needle release, dynamic fixation and now enzymatic fasciotomy. This has led to greater awareness of Dupuytren's. It is now time to transform this awareness into support for efforts to develop an actual cure.

Luck and Dupuytren's

Needle aponeurotomy for Dupuytren's is not that new. It's a new twist on the very first operation described for Dupuytren's, percutaneous fasciotomy, which was performed by Cooper years before Dupuytren's famous presentation. Adams wrote extensively about his results with percutaneous fasciotomy for Dupuytren's in the late 1800s. Before Lermusiaux began using a needle for percutaneous fasciotomy and calling it needle aponeurotomy, the last doctor to have much experience with the technique was Vernon Luck, who used his own "Luck Fasciotome", a tiny knife made in his machine shop, to perform percutaneous fasciotomy. Luck reported his concept of the biology of Dupuytren's along with his experience with his technique, and it's an interesting read. (full text: http://www.dupuytrenfoundation.org/DupPDFs/1959_Luck_1074.pdf)

Dermofasciectomy reconsidered

There are three mechanical approaches for Dupuytren's. In order of both increasing problems and long term effectiveness, these are: fasciotomy (cut fascia); fasciectomy (remove fascia); dermofasciectomy (remove both skin and fascia). The popularity of dermofasciectomy and skin grafting has been limited by concerns regarding complications of wound healing and loss of flexion. Some of these concerns stem from the historical use of dermofasciectomy as a revision procedure after failed fasciectomy, a group biased toward poor results. Dermofasciectomy as the primary or first operation is a different story. This study reviews technical tips for dermofasciectomy and shows that for patients with diffuse skin involvement, primary dermofasciectomy and skin grafting has a better chance of long term control than fasciectomy. http://www.dupuytrenfoundation.org/DupPDFs/2000_Armstrong_1046.pdf