Dupuytren’s Disease- My Journey

Abstract

In this thesis, I have presented in detail the background to DD addressing the history, biology and epidemiology (paper 1). Patients with this condition need to be seen efficiently and effectively; this can be achieved with an interdisciplinary clinic (paper 2). Patients’ problems and our solutions should be measured in the most patient-relevant way; this led to the development of a condition specific Southampton Dupuytren’s Scoring Scheme (paper 3) and more recently an even more suitable Patient Specific Functional Score (paper 9). The arrival of a “surgical drug” collagenase clostridial histolyticum opened up a novel therapeutic approach and proved particularly useful, in my clinical experience, for those cords too thick and too distal for needle fasciotomy in those patients who, accepting a higher recurrence rate, did not want surgery. The drug showed clinically satisfactory early results in pragmatic (rather than trial) conditions (paper 4 and paper 5); patients were in general satisfied although not if there was an initial poor correction or later recurrence (paper 6). CCH is technique dependent and with experience the use can be expanded (paper 7). In conclusion, treatment options for Dupuytren’s Disease are based on many factors defined by the disease, the patient and the surgeon; the management of each patient should be meticulously personalised (paper 8).

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ORCID for Timothy Underwood: orcid.org/0000-0001-9455-2188

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