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Type: Editorial
Published: 15-03-2019

 

Dupuytren’s disease—where to from here?

David B McCombe MD MBBS FRACS1,2,3

1

Department of Plastic and Maxillofacial Surgery
Royal Children’s Hospital
Parkville, Victoria
AUSTRALIA

 

2

Department of Paediatrics
Royal Children’s Hospital
Parkville, Victoria
AUSTRALIA

3

Victorian Hand Surgery Associates
Fitzroy, Victoria, 3065
AUSTRALIA

 

4

Section editor-Hand
Australasian Journal of Plastic Surgery
St Leondards, New South Wales,
AUSTRALIA

 

OPEN ACCESS

Correspondence

Name: David B McCombe

Address: Victorian Hand Surgery Associates
Suite C37, 41 Victoria Parade
Fitzroy, Victoria, 3065
AUSTRALIA

Email: david.mccombe@vhsa.com.au

Phone: +61 3 9412 8820

Citation: McCombe DB. Dupuytren’s disease—where to from here? Aust J Plast Surg. 2018;1(2):3–4.

Accepted for publication: 13 March 2019

Copyright © 2019. Authors retain their copyright in the article. This is an open access article distributed under the Creative Commons Attribution Licence, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited.


The advent of fasciotomy by intralesional collagenase injection has been a significant step forward in the treatment of Dupuytren’s contracture. While the therapeutic benefit of collagenase injection in the treatment of Dupuytren’s contracture has been established, seeking its value relative to the surgery has stimulated an interesting debate about the management of the condition, causing us to examine the results of surgery in more detail. Dupuytren’s disease and its treatment has become topical and will be the subject of the hand surgery symposium at this year’s Plastic Surgery Congress in May.

In this journal, the cost effectiveness of the treatment has been examined by both Livingston et al1 and Elliott et al2 in the public hospital setting with differing models of calculation. The funding of a new treatment is a thorny issue, particularly in the environment of limited resources that we are confronted by in both the public and private health systems, and it is important to examine the cost carefully. With this in mind, both papers conclude collagenase is a cost effective treatment relative to surgery, albeit with caveats.

So, should we abandon the scalpel in Dupuytren’s disease in favour of the needle? There is widespread enthusiasm for the new technology of collagenase treatment but this has been tempered, in the manner of most new technologies, by the reality in this case of recurrent or persistent contracture. It is timely therefore, that Behan3 brings us his technical refinement for wound closure after fasciectomy, and reminds us that there remains a place for surgical innovation in this complex and often frustrating condition.

References

  1. Livingston R, Wagels M, Heald A. Using collagenase to treat Dupuytren’s disease: a hypothetical cost benefit analysis. Aust J Plast Surg. 2019;2(1):23–30.
  2. Elliott D, Bindra R, Roychowdhury S, Comans T, Fletcher J. Collagenase injections for Dupuytren’s in Australian public hospitals: a cost analysis. Aust J Plast Surg. 2019;2(1):17–22.
  3. Behan F. Dupuytren’s disease: using keystone techniques to improve vascular dynamics. Aust J Plast Surg. 2019;2(1):8–16.