Guideline sources The following summarized guidelines for the management of dupuytren's contracture (DC) are prepared by our editorial team based on guidelines from the Dutch Multidisciplinary Guideline (DMG 2022) and the German Society of Radiation Oncology (DEGRO 2015). 1 2 Guidelines 1. Medical management Conservative management: insufficient evidence to recommend noninvasive treatments as primary therapy in patients with primary DC. I 2. Therapeutic procedures Collagenase injections: administer collagenase injections in patients with DC only in clinical trials. E Radiotherapy: As per DMG 2022 guidelines, offer radiotherapy in patients with DC only in clinical trials. E As per DEGRO 2015 guidelines, offer radiotherapy in patients with DC in the earlier nodular stages (N and N/I). B https://web.pathway.md/diseases/receui5VgIY6u1cno 1/3 6/29/23, 10:23 PM Dupuytren's contracture Pathway 3. Perioperative care Preoperative splinting: insufficient evidence to recommend preoperative orthosis fabrication in patients with DC. I Preoperative external fixation: insufficient evidence to recommend external fixation in patients with DC. I Perioperative arthrolysis: insufficient evidence to recommend perioperative arthrolysis in cases where a flexion contracture remains after partial fasciectomy. I 4. Surgical interventions Indications for surgery: Inform patients of the following before offering surgery: surgery cannot result in a completely straight finger or removal of the entire affected fascia wound healing takes time, and scar tissue is to be anticipated intensity and duration of the postoperative period possibility of recurrence. E Reconsider performing surgery in case of the following relative contraindications: immunosuppressive therapy anticoagulant therapy smoking diabetes mellitus vascularly compromised upper extremities. E Partial fasciectomy: Perform partial fasciectomy as first-line treatment in patients with DC. E Perform partial fasciectomy in patients with primary DC with a positive tabletop test. E Dermofasciectomy: Perform dermofasciectomy when the skin above the strand cannot be saved and in cases of persistent recurrence. E Consider performing dermofasciectomy in young patients with a strong diathesis. E Percutaneous needle fasciotomy: consider performing percutaneous needle fasciotomy in elderly patients with a palpable strand, as well as in relatively younger patients with a palpable strand if they wish for a minimally invasive treatment while accepting the higher recurrence rate. E Show 2 more Segmental fasciectomy: insufficient evidence to recommend segmental fasciectomy in patients with DC. I Radical fasciectomy: insufficient evidence to recommend radical fasciectomy in patients with DC. I Salvage techniques: consider offering salvage techniques in patients with severe recurrent contracture when partial fasciectomy does not lead to improvement and in cases with vascular https://web.pathway.md/diseases/receui5VgIY6u1cno 2/3 6/29/23, 10:23 PM Dupuytren's contracture Pathway insufficiency or damaged sensation. E 5. Follow-up and surveillance Postoperative rehabilitation: inform patients about the intensity of the postoperative protocol, the duration of wound healing and scar formation, and the cost coverage of hand therapy. E Show 3 more Clinical findings Past medical history Medication history Frozen shoulder Anticonvulsants Human immunodeficiency virus infection Musculoskeletal exam Ledderhose disease Digital flexion contracture Peyronie's disease Garrod's pads Palmar bands Social history Palmar nodules Alcohol consumption tabletop test Manual labor Occupational exposure to vibration Tobacco use Integument exam Palmar skin thickening References 1. Marius A Kemler, Robert S de Wijn, Annet L van Rijssen et al. Dutch Multidisciplinary Guideline on Dupuytren Disease. J Hand Surg Glob Online. 2022 Dec 24;5 2 178 183. Open 2. M Heinrich Seegenschmiedt, Oliver Micke, Marcus Niewald et al. DEGRO guidelines for the radiotherapy of non-malignant disorders : part III hyperproliferative disorders. Strahlenther Onkol. 2015 Jul;191 7 541 8. Open https://web.pathway.md/diseases/receui5VgIY6u1cno 3/3