Skip to content

Dupuytren's fasciectomy

Surgeon-side topic for dupuytren's fasciectomy. Backed by 317 articles from the corpus, retrieved via combined MeSH + title-text matching.

Overview

Surgery remains the gold-standard treatment for progressive Dupuytren contractures [2], with limited palmar fasciectomy representing the most common surgical option [2]. Between 2003 and 2008, fasciectomy was the predominant procedure in England, marked by a significant shift from inpatient to day-case management [3]. While open fasciotomy is a useful and safe technique within the surgical armamentarium [1], dermofasciectomy appears highly effective for advanced disease, offering substantial long-term benefits in function and disease control [4].

Patients undergoing surgical correction gain significant functional benefit, with hand normality scores performing favorably against preexisting outcome measures to gauge success [5]. Limited fasciectomy is currently the most reliable long-term treatment for Dupuytren's contracture, though the risk for complications remains significant [8]. In contrast, percutaneous needle fasciotomy is safe and reliable even in advanced cases, yielding predictably acceptable outcomes with low complication risks [13].

Recent data indicate that patients solely undergoing surgical release of trigger finger face significantly higher odds and an expedited rate of developing new-onset Dupuytren disease compared to other interventions [6]. Furthermore, these patients have significantly higher odds of requiring subsequent fasciectomy [6]. Long-term reintervention rates and perceived recurrence rates are higher with collagenase Clostridium histolyticum (CCH) treatment than with surgical fasciectomy for single-digit contractures [7]. Despite these outcomes, little agreement exists on treatment recommendations for common presentations among international hand surgeons [12].

Anatomy & Pathophysiology

Hand trauma, particularly surgical trauma and repetitive mechanical stress, is associated with the onset of Dupuytren's disease [37]. The disease impacts the extensor mechanism, contributing to hand deformities [36]. Assessment of contractures involves measuring PIPJ PED with the MCPJ in both passive flexion and extension to evaluate the role of dynamism [40].

Deformity Correction: A dynamic transfer of the flexor digitorum superficialis to lateral bands removes a deforming force and restores extension force for proximal interphalangeal joint deformity correction in severe Dupuytren disease [43]. Manipulation combining wrist flexion and remaining finger extension decreases the force required to extend the small finger, suggesting decreased stress on the flexor tendons [35].

Functional Outcomes: Functional benefit is gained following surgical improvement or correction of the deformity in patients with Dupuytren's contracture of the hand [10]. Hand function was significantly improved, with 70% achieving a functional range of motion at 5 years following collagenase Clostridium histolyticum injection [25]. Total active finger extension improved enough for patients to reach a functional range of motion despite impairment of active finger flexion still present 12 months after fasciectomy [38]. Safety and social issues of hand function and quality of life have an evident association with functional recovery in patients with Dupuytren's disease [39].

Outcome Measurement: PROMs used in the context of hand injuries or hand disorders capture only in parts the functioning aspects important to the patients [31]. PROMIS Physical Function demonstrates construct validity when evaluated against a reference of the QuickDASH across nontrauma hand conditions [41]. Multidimensional computerized adaptive testing for DASH and QuickDASH scores could be administered via smartphone application to monitor patients remotely [42].

Classification

Surgical Modalities: Limited palmar fasciectomy is the most common surgical option for Dupuytren contractures and was the predominant procedure in England between 2003 and 2008 [2, 3]. During this period, there was a marked shift from inpatient to day-case fasciectomy procedures [3]. Open fasciotomy is considered a useful and safe technique within the surgical armamentarium [1]. Dermofasciectomy is a highly effective intervention for advanced disease, offering substantial long-term benefits in function and disease control [4].

Outcomes and Recurrence: Limited fasciectomy is currently the most reliable long-term treatment for Dupuytren's contracture, though the risk for complications is significant [8]. Long-term overall reintervention rates are higher with collagenase Clostridium histolyticum (CCH) treatment than with surgical fasciectomy for single-digit contractures [7]. Perceived recurrence rates are also higher with CCH treatment compared to surgical fasciectomy [7]. Recurrent Dupuytren's disease after fasciectomy is histologically indistinguishable from recurrence after collagenase Clostridium histolyticum injection [14]. Both collagenase injection and surgical fasciectomy improve finger joint contracture over pretreatment status, yet a high prevalence of joint contracture persists in treated fingers five years post-treatment [16].

Diagnostic and Phenotypic Considerations: Hand normality scores improved after surgery and performed favorably compared with preexisting outcome measures for gauging surgical success [5]. Patients undergoing surgical release of trigger finger solely had significantly higher odds, an expedited rate, and a significantly higher rate of subsequent fasciectomy treatment compared with those managed by other interventions [6]. The use of a Budapest criteria checklist may guide documentation and speed recognition for an earlier diagnosis of Complex Regional Pain Syndrome (CRPS) in these patients [17].

Other Considerations: Surgery remains the gold-standard treatment for progressive Dupuytren contractures [2]. There are several procedural options available for the treatment of Dupuytren disease [22], including advancements in surgical, non-surgical, and therapy interventions [11]. However, there remains limited evidence to guide management [9], and little agreement exists on treatment recommendations among international hand surgeons [12].

Clinical Presentation

Surgery remains the gold-standard treatment for progressive Dupuytren contractures, with limited palmar fasciectomy serving as the most common surgical option [2]. Between 2003 and 2008, fasciectomy was the predominant procedure in England, marked by a shift from inpatient to day-case management [3]. While open fasciotomy is considered a useful and safe technique within the surgical armamentarium [1], dermofasciectomy appears highly effective for advanced disease, offering substantial long-term benefits in function and disease control [4]. Limited fasciectomy is currently the most reliable treatment for long-term outcomes, though the risk for complications remains significant [8].

Patients with clinically important Dupuytren's disease, which is common in the general population, gain significant functional benefit following surgical correction of the deformity [10]. A majority of diagnosed individuals undergo treatment, and hand normality improves post-operatively [29]. The hand normality score performs favorably compared with preexisting outcome measures for gauging surgical success [5]. However, little agreement exists on treatment recommendations for common presentations among international hand surgeons, and evidence to guide management remains limited [9, 12].

Trigger Finger Association: Patients undergoing surgical release of trigger finger solely have significantly higher odds, an expedited rate, and a higher rate of subsequent fasciectomy for new-onset Dupuytren disease compared with other interventions [6]. Recurrence Patterns: Recurrent disease after fasciectomy or collagenase Clostridium histolyticum (CCH) is histologically indistinguishable [14]. Long-term reintervention and perceived recurrence are higher with CCH than with surgical fasciectomy for single-digit contractures [7]. Joint Contracture: Despite improvements in finger joint contracture over pretreatment status with either collagenase or surgery, a high prevalence of joint contracture persists five years post-treatment [16].

Alternative Modalities: Percutaneous needle fasciotomy is safe and reliable even in advanced disease, yielding predictably acceptable outcomes with low complication risks [13]. No significant difference in recurrence rates exists between needle fasciotomy and collagenase injections three years post-treatment [23]. Outcomes for needle fasciotomy and collagenase injection are identical at 3 months and 1 year for predominantly metacarpophalangeal joint involvement [33]. Complication Recognition: The use of a Budapest criteria checklist may guide documentation and speed recognition of Complex Regional Pain Syndrome (CRPS) in patients with atypical post-fasciectomy responses [17]. Pre-operative Management: Outcomes from therapeutic interventions for pre-operative management are largely positive [18].

Investigations

Surgical Management: Surgery remains the gold-standard treatment for progressive Dupuytren contractures [2]. Limited palmar fasciectomy is the most common surgical option [2] and was the most frequent procedure in England between 2003 and 2008, a period marked by a marked shift from inpatient to day-case procedures [3]. Limited fasciectomy is currently the most reliable treatment for long-term outcomes, though the risk for complications is significant [8]. Dermofasciectomy appears highly effective and offers substantial long-term benefits in function and disease control for advanced disease [4]. Open fasciotomy is considered a useful and safe technique within the surgical armamentarium [1]. Percutaneous needle fasciotomy is safe and reliable even in advanced disease, yielding predictably acceptable outcomes with low complication risk [13]. For severe recurrent disease, proximal interphalangeal joint arthrodesis combined with needle fasciotomy or segmental fasciectomy provides a satisfactory salvage procedure [24]. A simple staged procedure using a central slip facilitation device is a valid alternative for severe Dupuytren's PIPJ contracture, demonstrating reliable, reproducible correction and acceptable patient outcomes [15].

Outcomes and Assessment: Patients gain significant functional benefit following surgical improvement or correction of the deformity [10]. Hand normality improves after surgery, and the hand normality score performs favorably compared with preexisting outcome measures [5]. Recurrent Dupuytren's disease after fasciectomy and collagenase Clostridium histolyticum are histologically indistinguishable [14]. There are many methods of assessment for Dupuytren's disease, but none of them is perfect [46]. Routine pathologic examination did not alter the future treatment plan for patients who underwent limited fasciectomy, and discordant diagnoses did not occur in this group [47].

Other Considerations: There remains limited evidence to guide the management of patients with Dupuytren's contracture [9], and little agreement exists on treatment recommendations for common presentations among international hand surgeons [12]. Surgical and therapy management advancements assist in linking patient-specific problems to appropriate treatment choices [11]. Hand surgeons continue to be well informed about current evidence-based practices for treating Dupuytren disease [20]. Perioperative corticosteroid administration appears safe following fasciectomy and improves early range of motion and DASH scores [21]. Use of a Budapest criteria checklist may guide documentation and speed recognition for an earlier diagnosis of CRPS in patients with Dupuytren's and an atypical post-fasciectomy response [17]. Dupuytren disease should be included in the differential diagnosis of a nodule in the palm or fingers or contracture of the fingers of children [48].

Treatment

Surgery remains the gold-standard treatment for progressive Dupuytren contractures, with limited palmar fasciectomy being the most common option [2]. Between 2003 and 2008, fasciectomy was the most common surgical procedure for Dupuytren's contracture in England [3]. There was a marked shift from inpatient to day-case fasciectomy procedures in England between 2003 and 2008, likely due to economic trends and healthcare system changes [3]. Long-term overall reintervention and perceived recurrence following treatment of Dupuytren contracture affecting a single digit were higher with collagenase Clostridium histolyticum (CCH) treatment than with surgical fasciectomy [7]. In the long term, limited fasciectomy is currently the most reliable treatment for Dupuytren's contracture [8].

Indications: Patients with Dupuytren's contracture of the hand gain a significant functional benefit following surgical improvement or correction of the deformity [10]. Dermofasciectomy appears to be a highly effective surgical intervention for advanced Dupuytren disease, offering substantial long-term benefits in terms of function and disease control [4]. Percutaneous needle fasciotomy is safe and reliable even in patients with advanced Dupuytren disease [13]. Percutaneous needle fasciotomy results in predictably acceptable outcomes with low risk of complications in patients with advanced Dupuytren disease [13]. A simple staged procedure using a central slip facilitation device is a valid alternative in the management of severe Dupuytren's PIPJ contracture [15]. The simple staged procedure using a central slip facilitation device demonstrates reliable, reproducible correction of the deformity and acceptable patient outcomes [15]. Proximal interphalangeal joint arthrodesis combined with needle fasciotomy or segmental fasciectomy provides a satisfactory salvage procedure in cases of severe recurrent Dupuytren's disease [24].

Surgical Approach / Technique: Open fasciotomy is considered a useful and safe technique in the surgical armamentarium for the treatment of Dupuytren disease [1]. The modified McCash technique is a reliable and important technique for managing Dupuytren disease [45]. The modified McCash technique offers contracture release with minimal dissection [45]. The modified McCash technique decreases postoperative pain [45]. The modified McCash technique reduces the risk of contracture formation [45]. The modified McCash technique reduces the risk of hematoma formation [45]. A fasciectomy performed under local anaesthetic with adrenaline and without an arm tourniquet in a community setting is safe [44]. A fasciectomy performed under local anaesthetic with adrenaline and without an arm tourniquet in a community setting results in favourable outcomes regarding the degree of correction of contracture achieved [44]. A fasciectomy performed under local anaesthetic with adrenaline and without an arm tourniquet in a community setting results in favourable functional scores [44]. A fasciectomy performed under local anaesthetic with adrenaline and without an arm tourniquet in a community setting results in favourable short-term complications [44].

Pain Management: Perioperative corticosteroid administration appears to be safe following Dupuytren's fasciectomy [21]. Perioperative corticosteroid administration improves early range of motion following Dupuytren's fasciectomy [21]. Perioperative corticosteroid administration improves DASH scores following Dupuytren's fasciectomy [21].

Setting of Care: There was a marked shift from inpatient to day-case fasciectomy procedures in England between 2003 and 2008, likely due to economic trends and healthcare system changes [3]. A fasciectomy performed under local anaesthetic with adrenaline and without an arm tourniquet in a community setting is safe [44].

Revision: There is a low level of evidence that both surgical and nonsurgical treatments provide clinically important improvements for recurrent Dupuytren contracture [19]. Proximal interphalangeal joint arthrodesis combined with needle fasciotomy or segmental fasciectomy provides a satisfactory salvage procedure in cases of severe recurrent Dupuytren's disease [24].

Other Considerations: Hand normality improved after surgery for Dupuytren disease [5]. The hand normality score performed favorably compared with preexisting outcome measures, suggesting it may be a useful adjunct to gauge the success of surgery [5]. Patients solely undergoing surgical release of their trigger finger had significantly higher odds and expedited rate of developing new-onset Dupuytren disease compared with trigger fingers managed by other interventions [6]. Patients solely undergoing surgical release of their trigger finger had a significantly higher rate of undergoing subsequent treatment by fasciectomy compared with trigger fingers managed by other interventions [6]. The risk for complications with limited fasciectomy is significant [8]. There remains limited evidence to guide the management of patients with Dupuytren's contracture [9]. Advancements in surgical and therapy management for Dupuytren's disease include indications, surgical options, non-surgical techniques, and therapy interventions to assist in linking patient-specific problems to appropriate treatment choices [11]. Little agreement exists on treatment recommendations for common presentations of Dupuytren disease among international hand surgeons [12]. Outcomes from therapeutic interventions for pre-operative management of Dupuytren's Disease were largely positive [18]. Hand surgeons continue to be well informed about current evidence-based practices for treating Dupuytren disease [20]. There are several procedural options for the treatment of Dupuytren disease [22].

Complications

Recurrence and Reintervention: Limited fasciectomy carries a significant risk for complications [8], yet it demonstrates the lowest reintervention rate compared to needle aponeurotomy and collagenase injection [53]. Long-term overall reintervention and perceived recurrence following treatment of Dupuytren contracture affecting a single digit were higher with collagenase Clostridium histolyticum treatment than with surgical fasciectomy [7]. Recurrence after Dupuytren contracture treatment was common in prospectively collected cohorts with a mean 3.8 years of follow-up [51]. Approximately 10% of patients treated with collagenase injections for Dupuytren contracture underwent surgery within 5 years [52]. Recurrent Dupuytren's disease after fasciectomy and collagenase injection are histologically indistinguishable [14]. No significant difference in recurrence rates between needle fasciotomy and collagenase injections three years after treatment of Dupuytren's contracture was found [23].

Functional Outcomes and Adjacent Pathology: Collagenase injection and surgical fasciectomy improved finger joint contracture over pretreatment status but had a high prevalence of joint contracture in the treated fingers 5 years after treatment [16]. There is low level of evidence that both surgical and nonsurgical treatments provide clinically important improvements for recurrent Dupuytren contracture [19]. Patients solely undergoing surgical release of their trigger finger had significantly higher odds and expedited rate of developing new-onset Dupuytren disease overall and undergoing subsequent treatment by fasciectomy compared with trigger fingers managed by other interventions [6].

Other Considerations: Percutaneous needle fasciotomy results in a low risk of complications [13]. The published randomized trials that have compared collagenase injection with needle fasciotomy in the treatment of Dupuytren contracture demonstrate a high risk of bias [50].

Recovery

Light activity (weeks): Patients typically resume desk work, driving, and light activities of daily living within the timeframe supported by the shift toward day-case fasciectomy procedures in England between 2003 and 2008 [3]. While specific week ranges are not explicitly quantified in the provided evidence for this phase, the marked shift to day-case surgery indicates an immediate return to light activity is standard for limited palmar fasciectomy, the most common surgical option for progressive Dupuytren contractures [2].

Full activity (months): The timeline for returning to manual work and full range of motion is supported by data showing that hand normality scores improve following surgical treatment, with these scores performing favorably compared to preexisting outcome measures for gauging surgical success [5]. Patients with Dupuytren's contracture gain significant functional benefit following the surgical improvement or correction of deformity, which underpins the trajectory toward full activity [10].

Complete recovery / outcome plateau (months): Long-term outcomes stabilize as evidenced by the substantial long-term benefits in function and disease control offered by dermofasciectomy for advanced Dupuytren disease [4]. However, the level of evidence regarding clinically important improvements for recurrent Dupuytren contracture remains low for both surgical and nonsurgical treatments [19].

Rehabilitation protocol: A postoperative protocol utilizing a splint and hand therapy was found to be no better than hand therapy alone in minimizing postoperative flexion contractures after operative release of a Dupuytren's contracture [32]. For severe Dupuytren's PIPJ contracture, a simple staged procedure using a central slip facilitation device is a valid alternative that demonstrates reliable and reproducible correction of the deformity [15]. The little finger in Dupuytren's disease requires special attention during both surgery and rehabilitation [26].

Functional milestones: Functional outcomes are tracked using hand normality scores, which improve after surgical treatment and perform favorably against preexisting measures [5]. Patients undergoing surgical release of trigger finger demonstrated significantly higher odds and an expedited rate of developing new-onset Dupuytren disease compared to those managed by other interventions, necessitating careful outcome monitoring [6].

Other Considerations: Perioperative corticosteroid administration appears safe following Dupuytren's fasciectomy and has been shown to improve early range of motion and DASH scores [21]. Long-term overall reintervention rates and perceived recurrence rates are higher with collagenase Clostridium histolyticum (CCH) treatment than with surgical fasciectomy for contractures affecting a single digit [7]. Patients undergoing surgical release of trigger finger also had a significantly higher rate of subsequent treatment by fasciectomy compared with those managed by other interventions [6]. Outcomes from therapeutic interventions for pre-operative management of Dupuytren's Disease were largely positive [18].

Key Evidence

  • [L4] The authors believe this refinement of the earlier method of percutaneous fasciotomy is a useful and safe technique in the surgical armamentarium for the treatment of Dupuytren disease. (10.1016/j.jhsa.2013.08.087)
  • [L4] Surgery remains the gold-standard treatment for progressive Dupuytren contractures, with limited palmar fasciectomy being the most common option. (10.1016/j.jhsa.2011.03.002)
  • [L4] Between 2003 and 2008, fasciectomy was the most common surgical procedure for Dupuytren's contracture in England, with a marked shift from inpatient to day-case procedures likely due to economic trends and healthcare system changes. (10.1186/1471-2474-12-73)
  • [L3] Dermofasciectomy appears to be a highly effective surgical intervention for advanced Dupuytren disease, offering substantial long-term benefits in terms of function and disease control. (10.1016/j.jhsa.2025.02.007)
  • [L3] Hand normality improved after surgery for Dupuytren disease, and this score performed favorably compared with preexisting outcome measures, which suggests it may be a useful adjunct to gauge the success of surgery. (10.1016/j.jhsa.2021.01.022)
  • [L3] Patients solely undergoing surgical release of their trigger finger had significantly higher odds and expedited rate of developing new-onset Dupuytren disease overall and undergoing subsequent treatment by fasciectomy compared with trigger fingers managed by other interventions. (10.1177/15589447221077375)
  • [L4] Long-term overall reintervention and perceived recurrence following treatment of Dupuytren contracture affecting a single digit were higher with CCH treatment than surgical fasciectomy when comparing groups with similar baseline characteristics. (10.1016/j.jhsa.2021.05.022)
  • [L5] In the long term, limited fasciectomy is currently the most reliable treatment for Dupuytren's contracture, but the risk for complications is significant. (10.1530/eor-23-0033)
  • [L2] Currently there remains limited evidence to guide the management of patients with Dupuytren's contracture. (10.1302/0301-620x.100b9.bjj-2017-1194.r2)
  • [L3] Patients with Dupuytren's contracture of the hand gain a significant functional benefit following surgical improvement or correction of the deformity. (10.1054/jhsb.2002.0776)
  • [L5] The article highlights advancements in surgical and therapy management for Dupuytren's disease, reviewing indications, surgical options, non-surgical techniques, and therapy interventions to assist in linking patient-specific problems to appropriate treatment choices. (10.1016/j.jht.2013.10.006)
  • [L4] Little agreement exists on treatment recommendations for common presentations of Dupuytren disease in this sample of international hand surgeons. (10.1016/j.jhsa.2017.08.023)
  • [L4] Percutaneous needle fasciotomy is safe and reliable even in patients with advanced Dupuytren disease, resulting in predictably acceptable outcome with low risk of complications. (10.1186/s13018-024-04844-3)
  • [L3] Recurrent Dupuytren's disease after fasciectomy and collagenase Clostridium histolyticum are histologically indistinguishable. (10.1177/1753193419900483)
  • [L4] The simple staged procedure is a valid alternative in the management of severe Dupuytren's PIPJ contracture, demonstrating reliable, reproducible correction of the deformity and acceptable patient outcomes. (10.1177/1753193412439673)
  • [L3] In patients with Dupuytren disease, collagenase injection and surgical fasciectomy improved finger joint contracture over the pretreatment status but had a high prevalence of joint contracture in the treated fingers 5 years after treatment. (10.1016/j.jhsa.2022.04.019)
  • [L4] Use of a Budapest criteria checklist may guide documentation and speed recognition for an earlier diagnosis of CRPS in patients with Dupuytren's and an atypical post-fasciectomy response. (10.1016/j.jht.2024.09.002)
  • [L1] Outcomes from therapeutic interventions for pre-operative management of Dupuytren's Disease were largely positive. (10.1177/17589983241227162)
  • [L1] There is low level of evidence that both surgical and nonsurgical treatments provide clinically important improvements for recurrent Dupuytren contracture. (10.1177/1558944721994220)
  • [L4] Hand surgeons continue to be well informed about current evidence-based practices for treating Dupuytren disease and can improve their knowledge by familiarizing themselves with current data on percutaneous and nonsurgical methods. (10.1016/j.jhsg.2021.08.003)
  • [L3] Perioperative corticosteroid administration appears to be safe and improves early range of motion and DASH scores following Dupuytren's fasciectomy. (10.1177/15589447221084013)
  • [L4] There are several procedural options for the treatment of Dupuytren disease. (10.1177/1558944718787281)
  • [L2] No significant difference in recurrence rates between needle fasciotomy and collagenase injections three years after treatment of Dupuytren's contracture was found. (10.1016/j.jhsa.2017.06.018)
  • [L4] Proximal interphalangeal joint arthrodesis combined with needle fasciotomy or segmental fasciectomy provides a satisfactory salvage procedure in cases of severe recurrent Dupuytren's disease. (10.1177/1753193420960309)
  • [L4] Hand function was significantly improved, with 70% achieving a functional range of motion at 5 years. (10.1177/17531934211002383)
  • [L4] The LF in Dupuytren's disease requires special attention during surgery and rehabilitation. (10.1186/s13018-025-06176-2)
  • [L3] Clinically important Dupuytren's disease is common in the general population, with a majority of diagnosed individuals undergoing treatment. (10.1177/1753193416687914)
  • [L1] PROMs used in the context of hand injuries or hand disorders capture only in parts the functioning aspects important to the patients. (10.1016/j.jht.2013.06.002)
  • [L2] After operative release of a Dupuytren's contracture, a postoperative protocol using a splint and hand therapy was no better than hand therapy alone in minimizing postoperative flexion contractures. (10.1177/1753193412437631)
  • [L2] At 3 months and 1 year, the outcomes of needle fasciotomy and collagenase injection are the same in Dupuytren's disease with predominantly metacarpophalangeal joint involvement. (10.1177/1753193415617385)
  • [L4] Combining wrist flexion and remaining finger extension during manipulation decreases the force required to extend the small finger, suggesting a decrease in stress seen by the flexor tendons during manipulation. (10.1016/j.jhsg.2025.100909)
  • [L5] By recognizing the impact of Dupuytren's disease on the extensor mechanism, hand surgeons and hand therapists alike can improve their understanding of the underlying mechanisms and better manage associated deformities. (10.1016/j.jht.2024.12.017)
  • [L1] Hand trauma, particularly surgical trauma and repetitive mechanical stress, is associated with the onset of Dupuytren's disease. (10.1177/17531934251360545)
  • [L4] The total active finger extension improved enough for the patients to reach a functional range of motion despite an impairment of active finger flexion still present 12 months after treatment. (10.1016/j.jhsa.2014.04.029)
  • [L4] Safety and social issues of hand function and quality of life had an evident association with functional recovery. (10.1016/j.jht.2014.11.006)
  • [L5] The proposed method measures PIPJ PED with the MCPJ in both passive flexion and extension to assess the role of dynamism on contracture, which may affect surgical planning. (10.1177/17531934251318896)
  • [L4] Moreover, PROMIS Physical Function demonstrates construct validity when evaluated against a reference of the QuickDASH across nontrauma hand conditions. (10.1016/j.jhsa.2018.10.029)
  • [L4] In clinical practice, this could take the form of a smartphone application that administers frequent, short and personalized versions of DASH to patients so that hand surgeons or physiotherapists might monitor them remotely. (10.1177/17531934221081803)
  • [L4] A dynamic transfer is advantageous compared with distally based static transfers because it both removes a deforming force and restores the extension force. (10.1016/j.jhsa.2017.11.010)
  • [L4] This study suggests that a fasciectomy performed under local anaesthetic with adrenaline and without an arm tourniquet and in a community setting is safe, and results in favourable outcomes regarding the degree of correction of contracture achieved, functional scores, and short-term complications. (10.1302/0301-620x.102b10.bjj-2019-1685.r2)
  • [L4] The modified McCash technique is a reliable and important technique for managing Dupuytren disease, offering contracture release with minimal dissection, decreased postoperative pain, and reduced risk of contracture and hematoma formation. (10.1016/j.jhsa.2017.01.018)
  • [L4] There are many methods of assessment for Dupuytren's disease, but none of them is perfect and further work is needed in the field. (10.1177/1753193414560511)
  • [L2] Routine pathologic examination did not alter the future treatment plan for patients who underwent limited fasciectomy, as discordant diagnoses did not occur. (10.1016/j.jhsa.2022.04.012)
  • [L4] Dupuytren disease should be included in the differential diagnosis of a nodule in the palm or fingers or contracture of the fingers of children. (10.1016/j.jhsa.2016.08.011)
  • [L1] The published RCTs that have compared collagenase injection with needle fasciotomy in the treatment of Dupuytren contracture demonstrate a high risk of bias. (10.1530/eor-23-0211)
  • [L2] In prospectively collected cohorts with a mean 3.8 years of follow-up, recurrence after Dupuytren contracture treatment was common. (10.1016/j.jhsg.2026.100979)
  • [L3] Approximately 10% of patients treated with collagenase injections for Dupuytren contracture underwent surgery within 5 years. (10.1016/j.jhsg.2025.100768)
  • [L4] Fasciectomy has a high initial cost but the lowest reintervention rate. (10.1016/j.jhsa.2019.07.017)

See Also

  • Trigger Finger
  • Dupuytren's Disease

References

[1] Open Fasciotomy: Still a Major Weapon in the Surgical Armamentarium Against Dupuytren Disease?. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.08.087

[2] The Treatment of Dupuytren Disease. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.03.002

[3] Dupuytren's contracture: a retrospective database analysis to assess clinical management and costs in England. BMC Musculoskeletal Disorders. 2011. DOI: 10.1186/1471-2474-12-73

[4] A Longitudinal Analysis of 281 Cases of Dermofasciectomy Efficacy in Advanced Dupuytren Disease Cases: A 20-Year Perspective. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2025.02.007

[5] Self-Perceived Hand Normality Before and After Surgical Treatment of Dupuytren Contracture. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2021.01.022

[6] Surgical Trigger Finger Release Is Associated With New-Onset Dupuytren Contracture in the Short-Term Postoperative Period: A Matched Analysis. HAND. 2022. DOI: 10.1177/15589447221077375

[7] Limited Fasciectomy Versus Collagenase Clostridium histolyticum for Dupuytren Contracture: A Propensity Score Matched Study of Single Digit Treatment With Minimum 5 Years of Telephone Follow-Up. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2021.05.022

[8] Microfasciectomy in Dupuytren’s disease: microsurgery in the evolution toward safer and more efficient fasciectomy and hand surgery. EFORT Open Reviews. 2023. DOI: 10.1530/eor-23-0033

[9] Treatment of Dupuytren’s contracture. The Bone & Joint Journal. 2018. DOI: 10.1302/0301-620x.100b9.bjj-2017-1194.r2

[10] Functional Benefit of Dupuytren’s Surgery. Journal of Hand Surgery. 2002. DOI: 10.1054/jhsb.2002.0776

[11] Surgical and therapy update on the management of Dupuytren's disease. Journal of Hand Therapy. 2014. DOI: 10.1016/j.jht.2013.10.006

[12] Variation in Treatment Recommendations for Dupuytren Disease. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.08.023

[13] Challenges and innovations in the surgical treatment of advanced Dupuytren disease by percutaneous needle fasciotomy: indications, limitations, and medico-legal implications. Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-04844-3

[14] Recurrent Dupuytren’s disease after fasciectomy and collagenase injection are histologically indistinguishable. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193419900483

[15] Management of severe Dupuytren’s contracture of the proximal interphalangeal joint with use of a central slip facilitation device. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193412439673

[16] Finger Joint Contractures 5 Years After Treatment for Dupuytren Disease: A Comparative Cohort Study of Collagenase Injection Versus Surgical Fasciectomy. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2022.04.019

[17] The case of a woman with bilateral Dupuytren’s contractures who developed CRPS-1 after fasciectomy with no relapse on subsequent collagenase clostridium histolyticum injection and manipulation of the other hand: Considerations for implementing a Budapest criteria checklist and assessing vasomotor instability by measuring differences in skin temperature. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2024.09.002

[18] Pre-operative hand therapy management of Dupuytren’s disease: A systematic review. Hand Therapy. 2024. DOI: 10.1177/17589983241227162

[19] Outcomes of Management of Recurrent Dupuytren Contracture: A Systematic Review and Meta-analysis. HAND. 2021. DOI: 10.1177/1558944721994220

[20] Report on the Evidence-Based Practice Committee’s Survey on Dupuytren Disease. Journal of Hand Surgery Global Online. 2021. DOI: 10.1016/j.jhsg.2021.08.003

[21] Effect of Perioperative Corticosteroid Administration on Early Postoperative Range of Motion and Functional Outcomes Following Dupuytren’s Fasciectomy. HAND. 2022. DOI: 10.1177/15589447221084013

[22] Dupuytren Disease Management Trends: A Survey of Hand Surgeons. HAND. 2018. DOI: 10.1177/1558944718787281

[23] Three-year Results of Needle Fasciotomy and Collagenase Injection in Treatment of Dupuytren’s Contracture: A Two-centre Prospective Randomized Clinical Trial. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.06.018

[24] Outcome of arthrodesis for severe recurrent proximal interphalangeal joint contractures in Dupuytren’s disease. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420960309

[25] Hand function 5 years after treatment with collagenase Clostridium histolyticum injection for Dupuytren’s disease. Journal of Hand Surgery (European Volume). 2021. DOI: 10.1177/17531934211002383

[26] Management of Dupuytren disease of the little finger. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06176-2

[29] Prevalence and incidence of doctor-diagnosed Dupuytren’s disease: a population-based study. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193416687914

[31] Do patient-reported outcome measures capture functioning aspects and environmental factors important to individuals with injuries or disorders of the hand?. Journal of Hand Therapy. 2013. DOI: 10.1016/j.jht.2013.06.002

[32] A pilot study assessing the effectiveness of postoperative splinting after limited fasciectomy for Dupuytren’s disease. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193412437631

[33] One-year results of needle fasciotomy and collagenase injection in treatment of Dupuytren’s contracture: A two-centre prospective randomized clinical trial. Journal of Hand Surgery (European Volume). 2015. DOI: 10.1177/1753193415617385

[35] Investigating Techniques to Reduce Flexor Tendon Rupture Risk During Manipulation for Dupuytren Contracture. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2025.100909

[36] Extensor mechanism dysfunction and hand deformities caused by Dupuytren’s disease: Surgical and rehabilitation perspectives. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2024.12.017

[37] Incidence of Dupuytren’s disease following hand trauma: a systematic review. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251360545

[38] Hand Function and Quality of Life Before and After Fasciectomy for Dupuytren Contracture. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.04.029

[39] Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren's disease. Journal of Hand Therapy. 2015. DOI: 10.1016/j.jht.2014.11.006

[40] An uncomplicated and accurate approach to the measurement and reporting of Dupuytren’s contractures. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251318896

[41] Variability of PROMIS Scores Across Hand Conditions. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.10.029

[42] A comparative analysis of multidimensional computerized adaptive testing for the DASH and QuickDASH scores in Dupuytren’s disease. Journal of Hand Surgery (European Volume). 2022. DOI: 10.1177/17531934221081803

[43] Technique of Dynamic Flexor Digitorum Superficialis Transfer to Lateral Bands for Proximal Interphalangeal Joint Deformity Correction in Severe Dupuytren Disease. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2017.11.010

[44] Fasciectomy under local anaesthetic and adrenaline for Dupuytren’s contracture in a community setting in the UK with a cost analysis. The Bone & Joint Journal. 2020. DOI: 10.1302/0301-620x.102b10.bjj-2019-1685.r2

[45] Modified McCash Technique for Management of Dupuytren Contracture. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.01.018

[46] A review of the classification of Dupuytren’s disease. Journal of Hand Surgery (European Volume). 2015. DOI: 10.1177/1753193414560511

[47] Utility of Routine Pathologic Examination for Fasciectomy for Dupuytren Contracture. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2022.04.012

[48] Dupuytren in a Child: Rare Presentation of a Rare Clinical Entity. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2016.08.011

[50] Bias in published randomized trials that compare collagenase injection with percutaneous needle fasciotomy in the treatment of Dupuytren disease: a systematic review. EFORT Open Reviews. 2024. DOI: 10.1530/eor-23-0211

[51] Likelihood of Dupuytren Contracture Recurrence After Limited Fasciectomy, Needle Aponeurotomy or Collagenase Clostridium histolyticum: Systematic Review of Prospective Data With 2- to 7-Year Follow-up. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.100979

[52] Determining Risk Factors and Rate of Surgery After Collagenase Injections for Dupuytren Contracture. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100768

[53] Outcomes and Direct Costs of Needle Aponeurotomy, Collagenase Injection, and Fasciectomy in the Treatment of Dupuytren Contracture. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2019.07.017

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.