Microscopic Fasciectomy in Dupuytren Disease: Early Clinical Outcomes and Technical Advantages-A District General Hospital Experience.

PURPOSE: This study aimed to compare the early postoperative outcomes of microscopic and open fasciectomy for Dupuytren contracture, with a focus on joint correction, residual deformity, survivorship, functional outcomes, and technical benefits.

METHODS

This retrospective review included 40 patients (120 joints) who underwent fasciectomy between January 2023 and January 2025. Microscopy was performed in 21 cases (52.5%). Data were collected on demographics, surgical details, before surgery and postoperative joint angles, residual deformity (defined as >20° at 15-24 weeks), predictors via logistic regression, Kaplan-Meier survivorship, Quick Disabilities of the Arm, Shoulder, and Hand scores, complications, learning curve for microscopy, and surgical staff surveys.

RESULTS

The mean age of the patients was 66 years, and 80% were men. The little finger (51.7%) and proximal interphalangeal joints (52.5%) were the most affected joints. Open fasciectomy targeted more severe preoperative contractures (mean, 54° vs 39°) and yielded greater absolute corrections (53° vs 38°), especially at the metacarpophalangeal joints. Microscopy showed lower residual deformity rates (20% vs 38%) and better correction maintenance with higher survivorship (72.5% overall). Multivariate analysis identified hand therapy sessions as a key predictor of residual deformity and microscopy-trended protective effect. The functional scores averaged 16, with no differences by technique. Complications occurred in 7.5% of the cases, with no notable difference between the groups. Microscopy's learning curve demonstrated increased efficiency over time, alongside intraoperative benefits, such as improved precision and ergonomics.

CONCLUSIONS

Early postoperative outcomes suggest that microscopic fasciectomy may offer modest short-term advantages in maintaining correction, with lower residual deformity, comparable functional outcomes, and a relatively rapid learning curve. Long-term studies are needed to establish whether these early findings support the broader adoption of microscopic techniques in hand surgery with structured training.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.