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Introduction The aim of the present study is to systematically review the literature on well-selected comparative studies for meta-analysis on outcome differences between collagenase clostridium histolyticum (CCH) injection and limited fasciectomy (LF) for Dupuytren’s disease. Materials and methods PubMed/Medline, Embase, and the Cochrane Library were searched for comparative studies assessing differences in outcomes of CCH and LF. Effect estimates were pooled across studies using random effects models and presented as weighted mean difference (MD) and odds ratio (OR) with corresponding 95% confidence interval (CI). Results A total of 11 studies encompassing 1′051 patients was included (619 patients in the CCH and 432 in the LF group). The residual contracture at a minimal average follow-up of three months was higher in the CCH group than in the LF group (27.8 vs. 16.2°, MD 11.6°, 95% CI [8.7, 14.5°], p < 0.001). The recurrence rate was significantly higher in the CCH group (25.8 vs. 9.3%, OR 5.2, 95% CI [1.5, 18.8], p = 0.01) while the rate of severe complications was significantly higher in the LF group (0.3 vs. 7.3%, OR 0.12, 95% CI [0.03, 0.42], p = 0.001). Conclusions Evidence of the present study confirms that CCH injection has a higher rate of disease recurrence whereas LF carries a higher risk for severe complications. It’s imperative that the trade-off between these aspects is considered, keeping in mind that CCH injections may be repeated in case of disease recurrence without increasing procedure related risks, especially in complex cases.

Objective To present the functional results obtained and the possible surgical difficulties after the surgical treatment of Dupuytren’s disease (DD) recurrence in patients previously treated with Clostridium histolyticum (CCH) collagenase. Materials and methods In this prospective study, 178 patients with DD were treated with CCH from 2011 to 2018; During long-term postoperative follow-up, 34 patients (19.1%) had recurrence of DD. In all patients injected in the IFP the disease recurred; In patients injected in the MCP, recurrence was highest in grade III and IV of the Tubiana classification, with involvement of the 5th finger and the two-finger Y-chord. Fourteen patients (7,8%) required surgery by partial selective fasciectomy due to recurrence of cord DD infiltration. The clinical and functional results of the patients, the difficulty of the surgical technique and the anatomopathological analysis of the infiltrated cords were evaluated in comparison with those of cords and patients who had had no previous CCH treatment. Results In all patients, cord rupture was achieved after injection, reducing joint contracture. In 14 patients, we observed during the follow-up the existence of DD recurrence that required surgical treatment by selective partial fasciectomy. There were no major difficulties in surgery and good clinical and functional results at 6 months of follow-up. The anatomopathological study of the resected tissue did not present histological alterations with respect to the samples obtained from patients initially treated by selective partial fasciectomy. Conclusions Selective fasciectomy after CCH injection does not lead to important operative difficulties, as long as the CCH injection is performed according to the recommendations. There were no histological changes in the tissue after CCH injection. Level of evidence III.

Background and Objectives: Dupuytren’s disease (DD) most commonly affects the palm and metacarpophalangeal/proximal interphalangeal joints; distal digital involvement at the distal interphalangeal joint (DIPJ) is uncommon and incompletely characterised. This systematic review summarises reported cases of DD involving the DIPJ, with or without proximal interphalangeal joint (PIPJ) involvement, focusing on clinical patterns, management, and reported outcomes. Materials and Methods: A systematic search of PubMed, Embase, and Scopus from database inception to July 2025 identified published case reports and case series describing DD confined to the DIPJ ± PIPJ of a single digit. Data were extracted on the demographics, digit involvement, anatomic features when reported, interventions, outcomes, complications, recurrence, and follow-up. Results: Nine studies reported 13 patients, published between 1991 and 2023. All patients were male (age range 25–79 years). The little finger predominated (10/13), followed by the ring (2/13) and index finger (1/13). When laterality was described, radial-sided distal cords were common. Surgical fasciectomy was performed in 11 cases and collagenase clostridium histolyticum (CCH) in 2 cases. Where postoperative correction was reported, outcomes were generally favourable; however, joint-specific range-of-motion outcomes and follow-up were inconsistently documented. Follow-up, when reported, ranged from 3 months to 3 years. One recurrence involving the PIPJ was reported 36 months after surgical management. No intraoperative neurovascular or tendon injuries were described, although adverse-event reporting was incomplete in some reports. Conclusions: Reported cases of DD involving the DIPJ most frequently involve the little finger in men. However, the available evidence is limited to a small number of selectively published case reports and series with incomplete outcome and follow-up reporting. These observations should therefore be interpreted cautiously, and comparative effectiveness or durability estimates cannot be established.

BackgroundDouble-eyelid surgery has been one of the most popular aesthetic surgeries in oriental populations. The objective of this study was to introduce a simple procedure for double-eyelid surgery.MethodsThe mini-incision blepharoplasty with pretarsal fasciectomy technique is described and illustrated. Blepharoplasty cases in our practice from June 2018 to December 2019 were retrospectively reviewed. Patients who underwent mini-incision blepharoplasty with pretarsal fasciectomy were followed up for at least 6 months.ResultsOf 280 blepharoplasty cases, 32 patients underwent mini-incision blepharoplasty with pretarsal fasciectomy on both upper eyelids. Nineteen patients experienced resolve of swelling within 5 days postoperatively. No loss of fold was observed during follow-up. The satisfaction rate was 93.8%.ConclusionsThe mini-incision blepharoplasty with pretarsal fasciectomy is ideal for selected patients requesting double-eyelid surgery. It provides stable, natural, scarless result with minimum complication and rapid recovery.Level of evidenceIV.

Aims Dupuytren’s contracture (DC) is a chronic debilitating fibroproliferative disorder. Common treatment options include collagenase clostridium histolyticum injections (CI), percutaneous needle fasciotomy (NF) and limited fasciectomy (LF). Superiority of one specific treatment remains controversial. This study aims to assess the short-term efficacy and safety of CI, NF, and LF for the treatment of DC. Methods We included randomized controlled trials of CI compared with placebo, NF and LF for patients with DC. PubMed, Embase and the Cochrane Library were searched from inception to August 2021. Contracture reduction rates in treated joints (within 0–5° of full extension within 30 days), relative reduction in total passive extension deficit (TPED), occurrence of one or more adverse events and number of treatment-related adverse events per patient were the outcomes of interest. The Cochrane risk-of-bias tool was employed for quality assessment of the studies. A network meta-analysis was performed using MetaXL. Results Nine studies met our inclusion criteria ( n  = 903). Overall, risk bias was mixed and mostly low. Short term TPED reduction achieved with LF was superior compared to CI and NF. Although CI achieved greater TPED reduction compared to NF, it was associated with the highest risk of overall adverse effects. The analyzed data was limited to a maximum three-year follow-up period and therefore insufficient for long-term outcome evaluation. Conclusions In DC, LF may be able to provide patients with severe disease, superior flexion contracture release postoperatively. CI is a valid treatment alternative to NF, however the higher risk of overall adverse effects must be considered. The quality-of-evidence is limited due to short-term follow-up periods and a lack of standardized definitions of complications and adverse events.

For patients who experience atypical neurogenic pain thought to be complex regional pain syndrome (CRPS) after Dupuytren’s fasciectomy early recognition has been reported to improve outcomes. Furthermore, given the progressive nature of Dupuytren’s, individuals with a history of CRPS have been “at risk” for further surgical intervention. To familiarize therapists with a Budapest criteria (BC) checklist for early diagnosis of CRPS, describe how tracking sudomotor/vasomotor signs alongside differences in skin temperature were used to monitor vasomotor instability and intervention effectiveness for a patient with atypical pain after fasciectomy and to detail management of the same patient with a CRPS history who had collagenase clostridium histolyticum (CCH) injection of her other hand without exacerbating CRPS. Case report. Medical record review was done by the author. Part 1- patient-reported symptoms and therapist-observed signs were mined and scored against the BC. Part 2- vasomotor/sudomotor signs and differences in skin temperatures (>1˚C) were used to interpret response to therapy and medical interventions. Part3- description and pictures of the process this patient underwent for CCH and manipulation. Part 1- therapist documentation failed to satisfy the BC. Part 2- vasomotor/sudomotor signs and skin temperature differences of >1˚C reflected the patient’s incomplete response to therapy and medication, thus strengthening need for percutaneous stellate ganglion sympathetic nerve blocks. Part 3- CRPS was not exacerbated with CCH procedure. Use of a BC checklist may guide documentation, speed recognition for an earlier diagnosis of CRPS in patients with Dupuytren’s and an atypical post-fasciectomy response. Once identified, observed signs and measures of skin temperature could be used to monitor response to therapy and medical interventions. The positive outcome for this woman with Dupuytren’s and CRPS-I after CCH injection are encouraging. •Therapists have tools to measure and monitor allodynia and vasomotor instability.•Measurement paired with Budapest criteria (BC) may improve neurogenic pain outcomes.•Monitor atypical fasciectomy recovery with BC checklist for earlier CRPS diagnosis.•Therapist usual method of documentation may change when using a BC checklist.•The BC qualifies skin temperature differences of >1°C as vasomotor instability.

Background Dupuytren’s contractures (DC) are fibrous cords under the skin of the hand that cause one or more fingers to curl gradually and irreversibly towards the palm. These contractures are usually painless but can cause a loss of hand function. Two treatments for Dupuytren’s contractures are widely used within the National Health Service (NHS) in the UK: removal of the contractures via surgery (limited fasciectomy) and division of the contractures via a needle inserted through the skin (needle fasciotomy). This study aims to establish the clinical and cost-effectiveness of needle fasciotomy (NF) versus limited fasciectomy (LF) for the treatment of DC in the NHS, in terms of patient-reported hand function and resource utilisation. Methods/design Hand-2 is a national multi-centre, two-arm, parallel-group randomised, non-inferiority trial. Patients will be eligible to join the trial if they are aged 18 years or older, have at least one previously untreated finger with a well-defined Dupuytren’s contracture of 30° or greater that causes functional problems and is suitable for treatment with either LF or NF. Patients with a contracture of the distal interphalangeal joint only are ineligible. Eligible consenting patients will be randomised 1:1 to receive either NF or LF and will be followed up for 24 months post-treatment. A QuinteT Recruitment Intervention will be used to optimise recruitment. The primary outcome measure is the participant-reported assessment of hand function, assessed by the Hand Health Profile of the Patient Evaluation Measure (PEM) questionnaire at 12 months post-treatment. Secondary outcomes include other patient-reported measures, loss of finger movement, and cost-effectiveness, reported over the 24-month post-treatment. Embedded qualitative research will explore patient experiences and acceptability of treatment at 2 years post-surgery. Discussion This study will determine whether treatment with needle fasciotomy is non-inferior to limited fasciectomy in terms of patient-reported hand function at 12 months post-treatment. Trial registration International Standard Registered Clinical/soCial sTudy ISRCTN12525655. Registered on 18th September 2020.

Background Dupuytren’s contracture is a hereditary disorder which causes progressive fibrosis of the palmar aponeurosis of the hand, resulting in digital flexion contractures of the affected rays. Limited fasciectomy is a standard surgical treatment for Dupuytren’s, and the one with the lowest recurrence rate; however, the recurrence is still relatively high (2–39%). Adipose-derived stem cells have been shown to inhibit Dupuytren’s myofibroblasts proliferation and contractility in vitro, as well as to improve scar quality and skin regeneration in different types of surgeries. Autologous adipose tissue grafting has already been investigated as an adjuvant treatment to percutaneous needle fasciotomy for Dupuytren’s contracture with good results, but it was only recently associated with limited fasciectomy. The purpose of REMEDY trial is to investigate if limited fasciectomy with autologous adipose tissue grafting would decrease recurrence compared to limited fasciectomy alone. Methods The REMEDY trial is a multi-centre open-label randomised controlled trial (RCT) with 1:1 allocation ratio. Participants ( n  = 150) will be randomised into two groups, limited fasciectomy with autologous adipose tissue grafting versus limited fasciectomy alone. The primary outcome is the recurrence of Dupuytren’s contracture on any of the treated rays at 2 years postoperatively. The secondary outcomes are recurrence at 3 and 5 years, scar quality, complications, occurrence of algodystrophy (complex regional pain syndrome), patient-reported hand function, and hypodermal adipose tissue loss at 1 year postoperatively in a small subset of patients. Discussion The REMEDY trial is one of the first studies investigating limited fasciectomy associated with autologous adipose tissue grafting for Dupuytren’s contracture, and, to our knowledge, the first one investigating long-term outcomes of this treatment. It will provide insight into possible benefits of combining adipose tissue grafting with limited fasciectomy, such as lower recurrence rate and improvement of scar quality. Trial registration ClinicalTrials.gov NCT05067764, June 13, 2022.

[LANGUAGE= \"English\"] BACKGROUND: Dupuytren’s contracture is characterized by the thickening of the palmar fascia. Although extensive literature exists on this disease, changes in lifestyle necessitate the re-evaluation of its epidemiology, etiology, and clinical features. This study aims to revise the current characteristics of Dupuytren’s contracture and to explore potential relationships between these characteristics and recurrence.METHODS: Patients who underwent surgery for Dupuytren’s contracture between January 2014 and December 2016 were included in this study. Electronic health records were reviewed to collect data on gender, age at surgery, age at the first signs of the disease, dominant hand, profession, cigarette and alcohol consumption, comorbidities and their treatments, the affected hand and digit, operative technique, type of anesthesia, degree of joint contracture severity, and presence of recurrence. Patients with and without recurrence were compared.RESULTS: A total of 69 patients were included (60 males, nine females) with a mean age of 68.4 years (range: 51-90 years). Unilateral hand involvement was significantly more common. Recurrence occurred in seven patients (six males, one female). Comparison between patients with and without recurrence revealed that involvement of the first ray was significantly associated with recurrence. Partial palmar fasciectomy was the most commonly performed surgical procedure for recurrence treatment. No other significant differences were observed between the groups. The initial contracture angles of the metacarpophalangeal joints were higher compared to those observed in recurrence, whereas the proximal and distal interphalangeal joints were similar.CONCLUSION: No new recurrence-independent epidemiological, etiological, or clinical factors were identified for Dupuytren’s contracture. However, first ray involvement was significantly associated with recurrence. Partial palmar fasciectomy was the primary surgical approach for treating recurrence. Metacarpophalangeal recurrence was less severe than the initial disease, while proximal and distal interphalangeal recurrences were similar in severity.[LANGUAGE= \"Turkish\"] AMAÇ: Dupuytren kontraktürü, avuç içi fasyasının kalınlaşmasıyla kendini gösterir. Tanımlanmasından itibaren birçok veri ortaya konmuştur. Fakat, güncel yaşamdaki değişiklikler, bu tür hastalıklarda epidemiyolojik, etiyolojik ve klinik değerlendirmelerin tekrarlanmasını gerektirmektedir. Bu çalışmada, Dupuytren kontraktürünün güncel özelliklerini ortaya koyarken bunların nüks ile olası yeni ilişkilerini de tanımlamak amaçlandı.GEREÇ VE YÖNTEM: Ocak 2014-Aralık 2016 tarihleri arasında ameliyat olan hastalar çalışmaya dahil edildi. Hastaların cinsiyet, yaş, bulguların ilk ortaya çıktığı dönemdeki yaş, baskın el, meslek, sigara ve alkol kullanımı, ek hastalıklar ve bunlara yönelik görülen tedaviler, etkilenen el, etkilenen parmak, ameliyat yöntemi, anestezi yöntemi, eklemlerin etkilenme açıları ve nüks durumu gibi verileri kayıt edildi. Nüks görülmeyen ve görülen hastaların verileri birbirleriyle karşılaştırıldı.BULGULAR: Çalışmaya 69 hasta dahil edildi (60 erkek, 9 kadın). Hastaların ameliyat zamanındaki yaş ortalaması 68.4 yıldı (51-90). Tek taraflı tutulum yüzdesi anlamlı olarak yüksekti. Yedi hastada nüks gelişmişti (6 erkek, 1 kadın). Nüks görülmeyen ve görülen hastalar karşılaştırıldığında, birinci parmak tutulumu olan hastalarda daha sık nüks saptandı. Nüks olan hastalarda ön planda parsiyel palmar fasiyektominin tercih edildiği saptandı. Nüks olmayan ve olan gruplar arasında diğer veriler açısından anlamlı fark saptanmadı. Nüks eden hastalarda ilk ameliyat öncesindeki metakarpofalangeal eklem açısının ikinci ameliyat öncesindeki metakarpofalangeal eklem açısından daha büyük olduğu saptandı.SONUÇ: Dupuytren kontraktürü nüksten bağımsız değerlendirildiğinde herhangi bir yeni epidemiyolojik, etiyolojik ve klinik veri saptanmadı. Birinci parmağı ameliyat edilen hastalarda nüks olasılığı daha yüksektir ve parsiyel palmar fasiyektomi, nüks tedavisinde ön planda tercih edilen cerrahi yöntemdir.

Background The palmar aponeurosis is extremely adherent to the skin above it. Many of the pre-tendinous coarse fibers enter the dermis at an angle, not just in the palmar creases but also throughout the palm. It’s difficult to distinguish whether Dupuytren’s illness starts in the skin’s dermis or the palmar aponeurosis since the skin adheres so closely to the palmar fascia. In this work, we have investigated the clinical and histological origins of Dupuytren’s disease, as well as its impact on the disease’s management. Methods A clinical prospective study was conducted on 47 patients, 42 males and 5 females, who presented with Dupuytren’s contracture in the hands (29 patients were bilateral and 18 one-sided), in the period between April 2012 and September 2020. Results Histologically, all our specimens showed chronic inflammatory skin lesions showing hyperkeratotic epidermal covering and dermal infiltration with aggregates of chronic inflammatory cells, mainly lymphocytes and plasma cells, proliferated vascular spaces, and fibrous stroma. Clinical satisfaction was excellent in 67(88.2%) hands, good in six (7.8%)hands, fair in three (4%) hands, and no poor results. Conclusions Dupuytren’s disease is a chronic inflammatory skin illness that can penetrate fascia, as we’ve proved histologically and surgically. For a considerable reduction in recurrence, the adhering skin and accompanying cord must be removed. Level of evidence IV – therapeutic study.