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Dupuytren Disease: European Hand Surgeons, Hand Therapists, and Physical Medicine and Rehabilitation Physicians Agree on a Multidisciplinary Treatment Guideline Results from the HANDGUIDE Study

Huisstede, Bionka M. A. Ph.D.; Hoogvliet, Peter M.D., Ph.D.; Coert, J. Henk M.D., Ph.D.; Fridén, Jan M.D., Ph.D.On behalf of the European HANDGUIDE Group

Plastic and Reconstructive Surgery: December 2013 - Volume 132 - Issue 6 - p 964e–976e
doi: 10.1097/01.prs.0000434410.40217.23
Hand/Peripheral Nerve: Original Articles
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Background: Multidisciplinary treatment guidelines for Dupuytren disease can aid in optimizing the quality of care for patients with this disorder. Therefore, this study aimed to achieve consensus on a multidisciplinary treatment guideline for Dupuytren disease.

Methods: A European Delphi consensus strategy was initiated. A systematic review reporting on the effectiveness of interventions was conducted and used as an evidence-based starting point for this study. In total, 39 experts (hand surgeons, hand therapists, and physical medicine and rehabilitation physicians) participated in the Delphi consensus strategy. Each Delphi round consisted of a questionnaire, an analysis, and a feedback report.

Results: After four Delphi rounds, consensus was achieved on the description, symptoms, and diagnosis of Dupuytren disease. No nonsurgical interventions were included in the guideline. Needle and open fasciotomy, and a limited fasciectomy and dermofasciectomy, were seen as suitable surgical techniques for Dupuytren disease. Factors relevant for choosing one of these surgical techniques were identified and divided into patient-related (age, comorbidity), disease-related (palpable cord, previous surgery in the same area, skin involvement, time of recovery, recurrences), and surgeon-related (years of experience) factors. Associations of these factors with the choice of a specific surgical technique were reported in the guideline. Postsurgical rehabilitation should always include instructions and exercise therapy; postsurgical splinting should be performed on indication. Relevant details for the use of surgical and postsurgical interventions were described.

Conclusion: This treatment guideline is likely to promote further discussion on related clinical and scientific issues and may therefore contribute to better treatment of patients with Dupuytren disease.

Rotterdam, The Netherlands; and Gothenburg, Sweden

From the Department of Rehabilitation Medicine and Physical Therapy and the Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC–University Medical Center Rotterdam; the Department of Hand Surgery, Sahlgrenska University Hospital; and the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg.

Received for publication March 8, 2013; accepted July 1, 2013.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. This study was realized with financial support from Fonds NutsOhra.

Bionka M. A. Huisstede, Ph.D., Erasmus MC–University Medical Center Rotterdam, Department of Rehabilitation Medicine and Physical Therapy, Room H-016, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands, bma.huisstede@gmail.com

©2013American Society of Plastic Surgeons