1. Significant functional impairment


2. PIPJ contracture

- originally thought to intervene early

- Macfarlane showed residual FFD always about 30o

- may need to release  check rein ligaments / accessory collateral ligaments


3. MCPJ contracture >30o


4. Trigger fingers

- must do limited fasciectomy 

- otherwise may get exacerbation


5. CTS 

- treat dupuytren's 1st then carpal tunnel if doesn't settle




Advanced RA

Trophic changes due to vascular insufficiency

Unfit for GA


Risk for Recurrence



- Garrod's pads highest risk

- foot and penis involvement

Family History

Bilateral / Radial and ulna involvement / multiple digits


Young patients and patients > 75





Partial Fasciectomy

Complete Fasciectomy

Dermatofasciectomy and STSG





Division of fascial cord

- Temporary method to relieve a severe MCPJ contracture

- not definitive therapy

- not in digits because high risk of neurovascular injury

- useful in elderly patients 

- results are better with dense mature cords 


Partial Fasciectomy


Dupuytrens surgery


Most common procedure


Recurrence rates of 50%

- need for repeat surgical procedure is only 15%




Longitudinal incision with Z plasty at end of case

- probably better with severe contracture as allows skin closure

- easier to protect NV bundles

- z at 60o


Careful flap elevation

- easy to button hole through skin


Dissection of NV bundles

- under then over spiral bands


Resection of diseased tissue


PIPJ  contracture > 30o


- released check rein / accessory collateral / volar plate /  capsulotomy / flexor sheath

- note that a extended finger which does not flex is more debilitating than a FFD


Skin gaps

- due to large contractures


- McCash open technique (secondary healing)



- let down tourniquet for haemostasis

- consider drain

- check finger vascularity




POP backslab in POSI

Wound check at 7 days

ROS 2 weeks

Night splint in extension for 3/12


Complete Fasciectomy 


Abandoned due high complication rate

- does not completely prevent recurrence of the disease


Dermatofasciectomy & FTSG



- recurrent disease

- young with diathesis / aggressive disease

- Recurrence under grafts very rare (Hueston)

- the FTSG as a fire break




Rarely necessary

- may be indicated if severe PIPJ flexion 

- skin from involved finger may be used to cover palmar skin defect

- finger is filleted & skin folded into palm as pedicle with neurovascular bundles


Adjunctive Procedures


Trigger Fingers 


Excise diseased fascia with release of the A1 pulley


Pulley release without local diseased fascial excision

- may instigate a rapid progression of the Dupuytren's disease


Carpal Tunnel Syndrome 


Prophylactic CTD at time of fasciectomy is unwise

- accelerated scar formation may cause poor result


Partial Fasciectomy with CTD at later date





- can be a problem for the skin

- lead to necrosis


Vascular Impairment/ Flap Necrosis

- finger white at end of procedure

- often due to vessel stretched after significant release

- bend fingers, leave tourniquet down

- papaverine on vessels as antispasmodic

- warm hand

- inspect vessels for damage

- wait


Nerve Injury


Reflex sympathetic dystrophy