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Treatment Options for Dupuytren’s Disease: Tips and Tricks

Treatment Options for Dupuytren's Disease

Keith A Denkler 1Keon Min Park 1Osaid Alser 2

Denkler KA, Park KM, Alser O. Treatment Options for Dupuytren’s Disease: Tips and Tricks. Plast Reconstr Surg Glob Open. 2022 Jan 27;10(1):e4046. doi: 10.1097/GOX.0000000000004046. PMID: 35186619; PMCID: PMC8849405.


  • 1Dept. of Surgery, Division of Plastic Surgery, University of California San Francisco, Calif.
  • 2Massachusetts General Hospital, Harvard Medical School, Boston, Mass.


Dupuytren’s disease (DD) is a common fibroproliferative condition of the hand.

Methods: Management of DD includes observation, non-operative management, and operative management. Operative treatments include percutaneous needle fasciotomy (PNF), open fasciotomy (OF), Clostridium collagenase histolyticum (CCH) injections, limited fasciectomy (LF) and dermofasciectomy (DF). The various methods of DD treatment are reviewed.

Results: We summarize the highlights of each treatment option as well as the strengths and weaknesses. PNF has an immediate improvement, but a higher recurrence rate, potential problematic skin tears, and rare tendon or nerve complications. Limited fasciectomy removes the thickened, diseased tissue but has a more prolonged recovery and has a higher rate of significant complications. Dermofasciectomy has the highest complication rate, and the lowest recurrence. Also, secondary fasciectomy after a previous dermofasciectomy has an unexpected amputation rate as high as 8%. Collagenase injections require two visits, have an increased number of minor side effects such as skin tears, and have rare but significant side effects such as tendon rupture.

Conclusions: This article gives an overview of different treatment options for DD and each of their strengths and weaknesses and provides procedural tips.


Latha Satish, M.Sc., M.Phil, Ph.D.

Dr. Satish is a trained biotechnologist with several years of experience in cell and molecular biology. Dr. Satish’s interest has been in skin research with a special focus on skin inflammation, infection, and fibrosis. The other arm of Dr. Satish’s research has been to study the molecular determinants of palmar fascial disease, Dupuytren’s contracture.

Her long-term interest has been to develop therapeutic agents to help alleviate the pain and distress of patients with Dupuytren’s. Her studies on Dupuytren’s disease were funded by a private donor, which moved the research forward to study this disease in an animal model, which was not feasible earlier. Dr. Satish’s research on Dupuytren has identified small molecules that can be used as a target to intervene with the progression and development of the disease.

Dr. Satish received her Ph.D. from a prestigious institute in India and did her post-doctoral training at the University of Pittsburgh. Currently, Dr. Satish serves as a faculty at the Division of Asthma Research, Cincinnati Children’s Hospital; named as the top hospital in the US. At Cincinnati Children’s, Dr. Satish researches Atopic Dermatitis, a chronic inflammatory skin disease affecting children and adults. Dr. Satish has published over 50 articles in peer-reviewed journals, review articles and book chapters.

Dr. Keith Denkler

Dr. Denkler is an accomplished, board certified plastic surgeon with expertise in aesthetic and reconstructive surgery. Dr. Denkler is a clinical professor of plastic surgery at UCSF and has a private practice in Marin County.

He is internationally renowned for his use of multiple approaches in treating the debilitating and disabling effects of palmar fibromatosis (Dupuytren disease). Dr. Denkler is an expert in needle aponeurotomy (NA), a minimally invasive procedure that uses subcutaneous needles to release the contracture as well as use of subcutaneous injection of collagenase. He has treated over 10,000 Dupuytren’s fingers, authored >35 publications and book chapters, presented internationally and domestically and is often cited for expert opinion in national and international news discussing Dupuytren’s. HIs pioneering investigational work documenting the safety of epinephrine with local anesthesia contributed to the origination of “wide-awake hand surgery”.

Dr. Denkler trained at prestigious medical institutions in the United States and Europe. He attended Baylor College of Medicine in Houston, Texas, followed by residency training in plastic and reconstructive surgery with the Cronin, Bauer, and Biggs group, also in Houston. Additionally, Dr. Denkler completed a hand surgery fellowship with Dr. Eugene Kilgore in San Francisco and one year of fellowship training in craniofacial surgery with Dr. Paul Tessier in Paris, France.

Dr. daiva bajorunas

Daiva Bajorunas MD is an endocrinologist with more than 25 years of experience in the biopharmaceutical industry.  She has a strong interest in advancing therapeutic options for conditions of significant unmet medical need. 

For the past decade, Daiva has been engaged as a consultant to the pharmaceutical industry, currently as Founder and Principal, DBMD Consulting, and previously as Chief Medical Officer / Chief Scientific Officer for Vault Bioventures. She has provided her expertise to enhance large, mid-size and small pharmaceutical company product development, clinical/regulatory, and life cycle strategies for both drugs and devices, including oral, transdermal, injectable and inhalative delivery systems, working across multiple therapeutic areas and geographies. She has considerable experience chairing Data Safety Monitoring Boards.   

In the past she held various R&D positions of increasing responsibility at Rhone-Poulenc Rorer, BMS, Aventis (acquired by Sanofi), and Kos Pharmaceuticals (acquired by Abbott). Before she joined industry, she held academic appointments at Memorial Sloan-Kettering Cancer Center and Cornell University Medical College (CUMC), and was Director of Clinical Care, Endocrinology Service, Memorial Hospital (MH), New York, NY. Daiva received her MD degree at the University of Michigan Medical School, did her residency training at St. Vincent’s Hospital & Medical Center in NY, her metabolism fellowship at Stanford University Medical Center, CA and her endocrinology fellowship at MH/CUMC, NY.