Dupuytren Disease Management Trends: A Survey of Hand Surgeons

Abstract

Background: Management of Dupuytren Disease is variable, and influenced by multiple factors including location, extent of disease, surgical preference and familiarity with different treatment techniques. The objective of this study was to determine current Dupuytren Disease management trends in Australia. Methods: A questionnaire was sent through The Australian Hand Surgery Society to all members. In addition to demographic data, indications and preferences for different management interventions were surveyed on location of disease, age and activity level of the patient. Results: 99 (48%) of the Australian Hand Surgery Society members completed the survey. Respondents were primarily Orthopaedic (50%) or Plastic (49%) Surgeons, and most worked in private (99%) and public (71%) practice. Surgeon’s believed that Tubiana’s treatment goals to correct deformity was the most important (60%) and to shorten post-operative recovery (60%) was the least important. Only 42% of respondents perform needle aponeurotomy for Dupuytren Disease. In contrast 70% of respondents perform collagenase injections, with manipulation most commonly undertaken on the second day (46%) and skin tears (52%) the most common complication. Seventy-five percent of the respondents feel there is sufficient evidence to support the treatment of Dupuytren disease with collagenase injections. Ninety nine percent of all respondents perform fasciectomes for Dupuytren Disease, with Limited (without graft) (76%) the most routine performed. Conclusions: Several procedural options for the treatment of Dupuytren Disease exist within Australia. This study shows current Australian practice trends and highlights the increasing use of collagenase.

Dupuytren's Disease: A Novel Minimally Invasive Pull-Through Technique

“…Several factors must be considered in the treatment decision, including the severity of the disease, the risk of complications, and the rate of relapse. 16 RF and dermatofasciectomy have fallen out of favor as more aggressive techniques, with higher complication rates, often requiring skin grafts and a prolonged postoperative rehabilitation process. 17 Percutaneous needle aponeurotomy (PNA) is a technique that has gained popularity in the recent period, as it is a simple procedure, which can be performed under local anesthesia on an outpatient basis.…”

“…Several factors must be considered in the treatment decision, including the severity of the disease, the risk of complications, and the rate of relapse. 16 …”

Dupuytren’s disease: using needles more across the world

“…However, PNF has never been popular with Australian surgeons, perhaps because of the learning curve and the long-term surgical influence of John Hueston with his teaching of DF and ‘firebreaks’ on the surgical population. In a 2020 survey ( Paynter et al., 2020 ), Australian surgeons believed that Tubiana’s treatment goal to correct the deformity was more important than shortening the post-treatment recovery. Less than half of the respondents performed PNF, while 70% performed CCH injections.…”