Dupuytren’s Disease — Biology, Cords, Fasciectomy, and Recurrence

This episode reviews the core principles of Dupuytren’s disease, focusing on pathophysiology, palmar fascial anatomy, clinical decision-making, and surgical treatment.Topics include Wnt signaling, fibroblast transformation into myofibroblasts, Type III collagen deposition, and the three disease phases: proliferative, involutional, and residual. The episode also reviews Dupuytren’s diathesis, including early onset, male sex, bilateral disease, family history, and ectopic disease such as Garrod pads, Ledderhose disease, and Peyronie disease.Anatomy is reviewed through the distinction between normal bands and pathologic cords, including the pretendinous cord, central cord, natatory cord, and the high-risk spiral cord. Key surgical safety concepts include displacement of the neurovascular bundle centrally, proximally, and superficially, the PSLG mnemonic, and the principle that Cleland’s ligament is spared while Grayson’s ligament is involved.Treatment strategies include needle aponeurotomy, collagenase injection, limited fasciectomy, McCash open palm technique, dermofasciectomy, full-thickness skin grafting as a biologic “fire break,” and sequential PIP capsulotomy. Additional topics include Hueston tabletop test, indications for intervention, hematoma prevention, flare reaction, night extension splinting, recurrence counseling, and the future potential of targeted molecular therapy. Part of Dr. Lara’s Plastic Surgery Compendium — a high-yield audio reference for plastic surgery trainees and surgeons.DisclaimerThis podcast is intended for educational purposes only and is designed for medical students, residents, fellows, and practicing healthcare professionals. It is not intended to provide medical advice, diagnosis, or treatment for any individual patient. The content presented reflects general surgical principles and should not be used as a substitute for formal medical training, clinical judgment, or consultation with qualified healthcare professionals. Listening to this podcast does not establish a physician–patient relationship.SEO / Topic KeywordsDupuytren’s disease, Dupuytren contracture, palmar fibromatosis, Wnt signaling, myofibroblasts, Type III collagen, Dupuytren diathesis, Garrod pads, Ledderhose disease, Peyronie disease, pretendinous cord, central cord, natatory cord, spiral cord, neurovascular bundle Dupuytren, Grayson ligament, Cleland ligament, Hueston tabletop test, needle aponeurotomy, collagenase injection, Xiaflex, limited fasciectomy, Brunner incision, McCash open palm technique, dermofasciectomy, full-thickness skin graft, PIP capsulotomy, flare reaction, night extension splinting