Surgical Management of Dupuytren Disease

Dupuytren disease is a benign fibroproliferative disorder of the palmar and digital fascia that may progress from nodules and cords to fixed flexion deformity, most often affecting the ring and small fingers. Although the biology of the disease is increasingly understood, no treatment is curative, and recurrence remains central to therapeutic decision making. This narrative review summarizes the contemporary surgical and minimally invasive management of Dupuytren disease, emphasizing limited fasciectomy, percutaneous needle fasciotomy or aponeurotomy, collagenase clostridium histolyticum injection, and dermofasciectomy. Current evidence suggests that minimally invasive procedures offer rapid recovery, low immediate morbidity, and acceptable functional improvement, but at the cost of earlier and more frequent recurrence. Limited fasciectomy remains a durable reference operation for functionally significant disease, particularly when longer disease-free intervals are prioritized. Dermofasciectomy is reserved mainly for severe, aggressive, or recurrent disease and may reduce recurrence beneath the graft, but it increases operative complexity and wound-related morbidity. The optimal strategy should be individualized according to contracture severity, joint involved, recurrence history, skin quality, comorbidities, rehabilitation capacity, and patient priorities. Shared decision making is therefore more defensible than any single universal algorithm.