# Dupuytren's Disease: A Novel Minimally Invasive Pull-Through Technique

## TL;DR

This paper introduces a new minimally invasive surgical technique for treating Dupuytren's disease, showing improved joint mobility and quality of life with low complication rates.

## Contribution

A novel minimally invasive pull-through surgical technique for Dupuytren's disease is introduced and evaluated for long-term outcomes.

## Key findings

- The pull-through technique achieved a mean total active extension deficit of 3.4 degrees at final follow-up.
- Patients showed a significant 10.7-point improvement in the QuickDASH score at 24 months.
- The recurrence rate was 15.4%, with low risk of neurovascular injury or tendon rupture.

## Abstract

Background
 Dupuytren's disease decreases quality of life significantly and often requires surgical treatment, nevertheless there is no actual gold standard. The aim of this study was to introduce the use of minimally invasive pull-through technique.

Methods
 From 2016 to 2020, 52 patients suffering from Dupuytren's contracture were treated with the minimally invasive pull-through technique. We evaluated the improvement in range of motion, pain, disability, and quality of life in the long term. Total extension deficit, quick disabilities of the arm, shoulder, and hand (QuickDASH), and EuroQol five dimensions—five levels index were systematically scored before each surgical intervention and reevaluated after 24 months.

Results
 Fourteen patients (26.9%) had already received a previous intervention (percutaneous needle aponeurotomy or collagenase
Clostridium histolyticum
). The mean preoperative total active extension deficit was 84.0 ± 23.3 degrees (55–130 degrees). Mean follow-up was 36 months. There were no cases of tendon rupture or neurovascular injury. Total active extension deficit at the final follow-up was 3.4 ± 2.3 degrees (0–12 degrees). The mean active range of motion of the MCP and PIP joints were, respectively, 90.5 ± 3.3 degrees (85–96 degrees) and 82.7 ± 2.5 degrees (80–87 degrees). At 24 months after cord excision, a mean 10.7 points improvement in the QuickDASH questionnaire was registered (
p
 < 0.001). Pull-through technique was equally effective both on patients with a primary or a recurrent disease. Eight patients (15.4%) had a recurrence of disease in the metacarpophalangeal joint or proximal interphalangeal joint.

Conclusion
 The pull-through technique is a simple, accessible, and effective technique for the treatment of Dupuytren's contracture. The use of palmar mini-incisions combined with minimal dissection has a low risk of iatrogenic injury to the neurovascular bundles and tendons, and has a low risk of recurrence rate. This study reflects level of evidence IV.