Despite a well-known fact that palmar fibromatosis leads to inability of finger extension several controversies are still remaining about Dupuytren disease that was originally described by Cooper. First of all, Dupuytren disease is not an emergency. We have to be patient to our patients, I always encourage them to express their ideas, concerns and expectations. Shared decision at the moment and some thoughts about life long plan are the key points for successful relationship of patient and physician. The strong consensus is seen in the literature for those points: Palmar fibromatosis is a chronic disease that is likely to be inherited. Handsurgery can extend the fingers but medicine doesn’t have any cure for the disease yet. Recurrence after any kind of treatment is possible. In my presentation I am going to show, how I solve debatable problems in my everyday practice. Kenalog injections help nodules soften in early stages of the disease. PNF will cost 2-3 days off the work. We expect recurrence to begin in 1,5-2 years. Open surgery will take at least a month to heal, recurrence might come around 10 years.

The goal of PNF is not only to stretch fingers but also to release all the skin folds. I always leave the palm opened and use V-Y skin plasty in case of open surgery. I mostly do PNF for primary cases and have no issues while operating afterwards. WALANT is the best anaesthesia for Dupuytren surgery. Splint is made of thermoplastic for tough PNF cases 3-5 days after the procedure. It is used for 3 months.

Keywords: Handsurgery, Dupuytren surgery, Expectations, Palmar fibromatosis

Abbreviations: PNF - percutaneous needle fasciotomy, WALANT - wide awake local anaesthetic no tourniquet.