Abstract

For those hand surgeons who have experienced early complications associated with limited fasciectomies (those who have not, have not done enough limited fasciectomies) and are frustrated by a high rate of recurrence or extension of the disease, incision of the cord and interposition of a full thickness graft is a technique to seriously consider. The procedure is not difficult to perform, but patience and attention to detail are prerequisites for success. That success is measured by complete or near complete release of the contracture with a minimum of morbidity, a nil recurrence rate, and extension rate of less than 10%. This technique is indicated for patients who have one or more elements of the Dupuytren's diathesis. Usually people older than 65 who develop Dupuytren's contracture do not have the diathesis, and their disease can be managed by limited fasciectomy and Z plasty skin lengthening. Finally, Dupuytren's disease presenting with no contracture can be managed effectively and conservatively by a series of intralesional injections of triamcinolone into the nodules and cords, the treatment of choice for all plantar nodules and knuckle pads.