Luck's landmark 1959 paper proposes a three-stage pathogenetic model for Dupuytren's contracture — proliferative, involutional, and residual — derived from histological study of over 200 affected hands, and uses this framework to argue for selective nodule excision and subcutaneous fasciotomy rather than routine radical aponeurectomy.
Before Luck, radical aponeurectomy — excision of the entire palmar fascia — was nearly universally adopted as the standard operation, performed without regard to disease stage or extent.
This paper is why modern hand surgeons target the nodule rather than the fascia. When you see a patient with Dupuytren's, the question is not "how much fascia to remove" but "where are the active nodules, and what stage are they in."
When a patient presents with a PIP contracture, plan your surgery at the digit — not the palm. Palmar clearance will not touch an interphalangeal contracture; only direct excision of the offending digital nodule addresses it.
Luck's three-stage model also explains why recurrence patterns differ: recurrence after fasciotomy alone means incomplete cord division; recurrence after complete nodule excision means new nodule formation, which radical aponeurectomy also cannot prevent. This framework directly legitimized the minimally invasive approaches — percutaneous needle fasciotomy and collagenase injection — that dominate contemporary practice.
Luck's landmark 1959 paper proposes a three-stage pathogenetic model for Dupuytren's contracture — proliferative, involutional, and residual — derived from histological study of over 200 affected hands, and uses this framework to argue for selective nodule excision and subcutaneous fasciotomy rather than routine radical aponeurectomy.
Before Luck, radical aponeurectomy — excision of the entire palmar fascia — was nearly universally adopted as the standard operation, performed without regard to disease stage or extent.
This paper is why modern hand surgeons target the nodule rather than the fascia. When you see a patient with Dupuytren's, the question is not "how much fascia to remove" but "where are the active nodules, and what stage are they in."
When a patient presents with a PIP contracture, plan your surgery at the digit — not the palm. Palmar clearance will not touch an interphalangeal contracture; only direct excision of the offending digital nodule addresses it.
Luck's three-stage model also explains why recurrence patterns differ: recurrence after fasciotomy alone means incomplete cord division; recurrence after complete nodule excision means new nodule formation, which radical aponeurectomy also cannot prevent. This framework directly legitimized the minimally invasive approaches — percutaneous needle fasciotomy and collagenase injection — that dominate contemporary practice.