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Dupuytren's contracture

Key sources
The following summarized guidelines for the management of dupuytren's contracture are prepared by our editorial team based on guidelines from the Dutch Multidisciplinary Guideline (DMG 2022) and the German Society of Radiation Oncology (DEGRO 2015).
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Guidelines

1.Medical management

Conservative management: insufficient evidence to recommend noninvasive treatments as primary therapy in patients with primary DC.
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2.Therapeutic procedures

Collagenase injections: administer collagenase injections in patients with DC only in clinical trials.
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  • Radiotherapy

3.Perioperative care

Preoperative splinting: insufficient evidence to recommend preoperative orthosis fabrication in patients with DC.
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  • Preoperative external fixation

  • Perioperative arthrolysis

4.Surgical interventions

Indications for surgery
Inform patients of the following before offering surgery:
surgery cannot result in a completely straight finger or removal of the entire affected fascia
wound healing takes time, and scar tissue is to be anticipated
intensity and duration of the postoperative period
possibility of recurrence
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Reconsider performing surgery in case of the following relative contraindications:
immunosuppressive therapy
anticoagulant therapy
smoking
diabetes mellitus
vascularly compromised upper extremities
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  • Partial fasciectomy

  • Dermofasciectomy

  • Percutaneous needle fasciotomy

  • Segmental fasciectomy

  • Radical fasciectomy

  • Salvage techniques

5.Follow-up and surveillance

Postoperative rehabilitation: inform patients about the intensity of the postoperative protocol, the duration of wound healing and scar formation, and the cost coverage of hand therapy.
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