Reviewed on : 6 Jun 2025

Reviewed by : Lucy Dyde Coventry & Warwickshire ICB IFR and Gateway Editor

Expires : 6 Jun 2027

Dupuytren’s Disease Surgery 

1. Category: Prior Approval

Prior approval from the Integrated Care Board (ICB) will be required before any treatment proceeds in secondary care unless an alternative contract arrangement has been agreed with the ICB that does not necessitate the requirement of prior approval before treatment

2. Background

This commissioning policy has been produced in order to provide and ensure equity, consistency and clarity relating to the approach to Dupuytren’s contracture release in adults by the Integrated Care Board (ICB) and is based on NHS England’s Evidence-Based Interventions (EBI) recommendations

Dupuytren’s is a progressive and lifelong genetic contracture of the fibrous elements related to the palmar fascia

The condition is caused by fibrous bands in the palm of the hand which draw the finger(s) (and sometimes the thumb) into the palm and prevent them from straightening fully

While the condition is not painful, the condition may lead to function limitation due to inability to open up the fingers completely

All treatments aim to straighten the finger to improve hand function. Despite treatment, deformities may likely recur following intervention and multiple procedures may be required, progressively increasing the risk of additional complication

Splinting and radiotherapy have not been shown be effective treatments of established Dupuytren’s contractures

Several treatments are available: needle fasciotomy, fasciectomy and dermofasciectomy.

None of these interventions are curative. Some have slower recovery periods, higher complication rates or higher re-operation rates (for recurrence) than others

The disease process affects the hand to varying degrees and patients may present at different stages in the disease process. It is hence important that the timing and choice of intervention is tailored to the individual patient and based on shared decision making between the patient and a practitioner with clinical expertise in the various treatment options

It is recommended that as part of the consultation process of patients undergoing intervention, a validated decision aid tool should be used during the consenting process to ensure that the patients’ desired outcomes have been considered

An example of decision aid tool is on the NHS website.

Currently there is a lack of consensus and high-quality evidence on the best and most cost- effective long-term treatment option, however, this may change in the future

Rationale for recommendation

Contractures usually progress and often fail to straighten fully with any treatment if allowed to progress too far. Larger interventions tend to carry a lower risk for recurrence, however are associated with complications that can lead to loss of function rather than overall improvement

NHS Coventry and Warwickshire Integrated Care Board Policy for Dupuytren’s contracture release in adults, June 2025, V2,

Significant complications with lasting impact after needle fasciotomy are very unusual (about 1%) and include nerve injury. Such complications after fasciectomy are more common (about 4%) and include infection, numbness and stiffness.

3. Eligibility Criteria

This intervention should not be undertaken for purely cosmetic purposes – which is in accordance with NHS policy more widely.

Treatment is not indicated in cases where there is no contracture, or the contracture is not progressing and does not impair function

• An intervention (Needle fasciotomy, fasciectomy and dermofasciectomy) should be considered for contractures with significant interference with function e.g. it significantly impacts an individual’s ability to use their fingers:

• Finger contractures causing loss of finger extension of 30° or more at the metacarpophalangeal joint or 20° at the proximal interphalangeal joint;
• OR
• Severe thumb contractures which interfere with function

A validated decision support tool could be used when consenting patients for possible intervention taking into account factors such as severity of deformity, patient choice and patient health status

An example of decision aid tool is on the NHS website.

As per NICE guidance, there is inadequate evidence to recommend the use of radiation therapy in the management of Dupuytren’s disease. It should only be used with special arrangement for clinical governance, audit or research

For patients who DO NOT meet the eligibility criteria, the ICB will only consider funding the treatment if an Individual Funding Request (IFR) detailing the patient’s clinical presentation is submitted to the ICB.