Dupuytren's disease: my personal view

Area of Science:

• Hand surgery
• Orthopedics
• Plastic surgery

Background:

• Dupuytren's disease presents treatment challenges due to limited randomized controlled trial (RCT) evidence.
• Variability in recurrence rates and complication significance across treatments complicates direct comparisons.
• Surgeons must balance patient preferences for recovery speed against recurrence risk.

Purpose of the Study:

• To highlight challenges in Dupuytren's disease research, including sparse RCT data.
• To emphasize the need for patient-centered treatment decisions.
• To advocate for judicious surgical intervention and risk mitigation strategies.

Main Methods:

• Review of existing literature on Dupuytren's disease treatment and research limitations.
• Discussion of factors influencing treatment choice and recurrence.
• Analysis of surgical risks and healthcare economic considerations.

Main Results:

• RCT evidence for Dupuytren's disease treatments is limited by design challenges.
• Recurrence rates are not directly comparable across different treatment modalities.
• Patient involvement is crucial in selecting treatments, often involving trade-offs.

Conclusions:

• Healthcare economics necessitate careful consideration of treatment necessity for Dupuytren's disease.
• A low threshold for primary skin grafting is recommended for high-risk patients (young, dense disease, genetic predisposition) to minimize revision surgery.
• Shared decision-making is essential for managing this heterogeneous condition.