This AAOS instructional course lecture by Rayan reviews Dupuytren disease from first principles. It covers palmar fascial anatomy, myofibroblast-driven pathophysiology, clinical staging, and indications and outcomes for the full range of nonsurgical and surgical treatments. It also formally distinguishes classic Dupuytren disease from non-Dupuytren palmar fascial disease — two entities with different prognosis and treatment implications.
When a patient presents with a palmar nodule or digital contracture, your first task is to determine whether this is classic Dupuytren disease or non-Dupuytren palmar fascial disease — the distinction drives the entire management decision.
If it is classic Dupuytren disease, operate when MCP contracture exceeds 30° or PIP contracture reaches 15° with a palpable cord. Do not wait longer on the PIP joint: it corrects less reliably than the MCP, and prolonged contracture beyond 60° risks central slip attenuation even after successful cord excision.
When choosing a technique, fasciectomy's 15% recurrence rate is the benchmark to beat. Dermofasciectomy with skin grafting is reserved for recurrent or severe primary disease with skin adherence. It eliminates subgraft recurrence but does not stop disease extension at the graft margins.
Before every Dupuytren dissection, specifically identify the spiral cord. It is most common in the small finger, and as PIP contracture deepens, the neurovascular bundle spirals around the cord and migrates medially and centrally. Directly beneath where you are cutting. Dissect proximal to distal, use loop magnification, and know the pathologic anatomy before you divide anything.
This AAOS instructional course lecture by Rayan reviews Dupuytren disease from first principles. It covers palmar fascial anatomy, myofibroblast-driven pathophysiology, clinical staging, and indications and outcomes for the full range of nonsurgical and surgical treatments. It also formally distinguishes classic Dupuytren disease from non-Dupuytren palmar fascial disease — two entities with different prognosis and treatment implications.
When a patient presents with a palmar nodule or digital contracture, your first task is to determine whether this is classic Dupuytren disease or non-Dupuytren palmar fascial disease — the distinction drives the entire management decision.
If it is classic Dupuytren disease, operate when MCP contracture exceeds 30° or PIP contracture reaches 15° with a palpable cord. Do not wait longer on the PIP joint: it corrects less reliably than the MCP, and prolonged contracture beyond 60° risks central slip attenuation even after successful cord excision.
When choosing a technique, fasciectomy's 15% recurrence rate is the benchmark to beat. Dermofasciectomy with skin grafting is reserved for recurrent or severe primary disease with skin adherence. It eliminates subgraft recurrence but does not stop disease extension at the graft margins.
Before every Dupuytren dissection, specifically identify the spiral cord. It is most common in the small finger, and as PIP contracture deepens, the neurovascular bundle spirals around the cord and migrates medially and centrally. Directly beneath where you are cutting. Dissect proximal to distal, use loop magnification, and know the pathologic anatomy before you divide anything.