Needle Aponeurotomy v Xiaflex v Open surgery for Dupuytren's

I love this paper by Marco Rizzo and company. If you don’t know him, Marco is an absolutely lovely human being and first-rate surgeon who was one of my teachers at Mayo Clinic. I learned needle aponeurotomy from him.

Rizzo and team take a good look at options for Dupuytren’s Contracture

TL;DR: open surgery patients get fewer repeat interventions than Needle Aponeurotomy or Xiaflex patients (but I personally believe treatment fatigue plays a big role here—recovery is tougher). NA tends to have fewer repeat interventions than Xiaflex per finger and at much lower cost per finger. I think that if we looked per patient, costs would be even lower, as I can treat as many joints as I need to with needle aponeurotomy, but am limited to 2 per month with Xiaflex.

I personally use Xiaflex most often for very eccentric and/or “gummy” cords. For central, taut, “guitar strings,” I prefer Needle Aponeurotomy