Minimally invasive options in Dupuytren's contracture: aponeurotomy, enzymes, stretching, and fat grafting.

LEARNING

OBJECTIVES

After studying this article, the participant should be able to: (1) Perform needle aponeurotomy, fat grafting, Digit Widget insertion, and collagenase injection for Dupuytren's cords. (2) Describe how cords can be stretched without surgery. (3) Explain to patients the risks and benefits of these new alternatives of treatments.

SUMMARY: Surgery for Dupuytren's contracture used to be the only alternative of treatment. The past 5 years have seen the widespread adoption of minimally invasive treatments in the form of needle aponeurotomy and collagenase injection to disrupt the cords and restore range of motion. Even newer and perhaps as effective treatments such as fat grafting and mechanical stretching with the Digit Widget may also end up being important tools of treatment. The reader will be introduced to all of these modalities with text, illustration, and videos.